Webinar Veterans Aid & Attendance Benefit: A Provider s s Perspective 1
Benefits of Helping Residents Apply for VA Benefit Provide an additional customer service. Application may result in financial assistance for resident. May prevent spend down of resident s financial assets. Establish good-will amongst new residents and relatives. 2
Important Warnings Providers should offer assistance to apply for VA Benefits as a free benefit to the resident. VA law prohibits any company, entity, or organization from charging anyone for application assistance. Do not guarantee that application will yield financial assistance from Veterans Affairs. 3
What is Aid & Attendance? Aid & Attendance provides additional funds to eligible applicants who need care in assisted living residences, skilled nursing facilities or those receiving inhome care. A medical needs-based program. A financial needs-based program. 4
Aid & Attendance is a benefit paid in addition to another VA monthly benefit such as: VA pension, VA compensation, or VA Dependency and Indemnity compensation (DIC), or VA Death Pension 5
Applicants must apply for and be eligible for a: VA Pension, or VA Compensation, or VA Dependency and Indemnity Compensation (DIC) benefit, or VA Death Pension in order to receive the Aid & Attendance supplemental payment. 6
Who is Eligible for the Aid & Attendance? Veterans Spouses of veterans Surviving spouses of a veteran Some parents of deceased veterans Dependent children 7
General Annual Income Limit Thresholds for Aid & Attendance Veteran with no dependents: $18,234 Veteran with dependent spouse: $21,615 Surviving spouse no dependent children: $11,715 Surviving spouse with dependent child: $13,976, increases by $1,866 for each additional child. 8
Providers Preparation Download the following forms from www.va.gov/vaforms/ VA Form 21-526 VA Form 21-527 VA Form 21-534 VA Form 21-535 VA Form 21-4138 VA Form 21-4142 (For Physician) Create a standard letter on facility letterhead to detail care and services costs, admission date. Establish contact with regional VA office Outreach Coordinator. 9
Admissions During the admissions period ask the incoming resident if they are related to a wartime veteran or are a veteran. Choose a time soon after admission to work out details of preparing to apply for VA benefits. Ask resident and family to collect documentation. 10
Collect Documentation Social Security Number Military separation papers, or a DD 214 Marriage and death certificates Medical Insurance Policies Banking and Asset Information Name of applicant s Physician 11
Where To Start With Applicant Determine veteran eligibility first. Husbands, wives, widows, widowers, parents, or dependent children must be or must have been related to a veteran who served during wartime in order to receive the benefit. 12
Veteran Eligibility Criteria Veteran eligibility criteria applies to all applications and is key to determining eligibility of any applicant to receive benefits. Veteran must have served at least 90 days of active military service, at least one of those days during a period of war. Veteran must have been discharged under a favorable condition category. A dishonorable discharge disqualifies applicant. 13
Eligible War Time Periods World War II: 12/7/41 to 12/31/46 Korean Conflict: 6/27/50 to 1/31/55 Vietnam War: 2/28/61 to 5/7/75 for veterans who served in the Republic of Vietnam during that time. All other Vietnam veterans 8/5/64 to 5/7/75. Persian Gulf War: 8/2/90 through a date to be set by Presidential proclamation. Other war time periods see www.va.gov. 14
Which Form To Use? Consider the applicant and relationship to the veteran. Is the applicant a veteran, a spouse of a veteran, a surviving spouse of a veteran, or parent of a deceased veteran? 15
Obtain VA Forms visit: www.va.gov/vaforms/ *VA Form 21-526 (Veterans application for compensation and/or pension) VA Form 21-527 (Income-Net worth and employment statement) *VA Form 21-534 (For Dependency & Indemnity Compensation, Death Pension & Accrued Benefits by Surviving Spouse or Child) VA Form 21-535 (for Dependency & Indemnity compensation by Parent (s) including accrued benefits & death compensation when applicable) VA Form 21-4138 (Statement in support of claim) VA Form 21-4142 (For Physician) 16
VA Form 21-526 Use if the applicant is a: Veteran, Veteran with spouse, or Veteran with a dependent child/children. VA Form 21-526 is for veterans applying for compensation and or pension benefits. Determine if applicant is applying for Disability Compensation or Pension Benefit or both to find out which parts of VA 21-526 need to be filled out. 17
How to Determine if Veteran Applicant Should Apply for Compensation Benefit on Form 21-526? (Disability) Compensation Benefit is paid to a veteran if ANY of the following are true: Veteran injured during service. Veteran was seriously ill while in the service and veteran believes condition is continuing. Veteran developed a mental or physical condition that may be related to military service. Veteran is permanently and totally disabled and veteran believes it is because of military service. Fill out Part B of VA Form 21-526 for Compensation Benefit. 18
How to Determine if Veteran Applicant Should Apply for Pension Benefit on VA Form 21-526? Pension benefit paid to a wartime veteran with limited income and who is permanently and totally disabled or older than 65 years of age. Apply for pension benefit if all the following conditions apply: Applicant is permanently and or totally disabled (but not as a result of military service) Applicant served on active duty during a wartime period. Applicant has limited income. continue 19
How to Determine if Veteran Applicant Should Apply for Pension Benefit on VA Form 21-526? Financial income criteria apply. Criteria determined by VA formula for countable income and net worth. For Pension Benefit Fill Out Parts A, C if dependents, and Part D on VA Form 21-526. 20
VA Form 21-526 Form 21-526 divided into four parts. Every applicant fills out Part A. Determine if applying for compensation or pension or both. Compensation Benefit fill out Parts A, B, and C if there are any dependents. Pension Benefit fill out Parts A, C if there are dependents, and D. For Compensation & Pension fill out Parts A, B, C if there are dependents, and D. 21
Spouses Who qualifies as a Dependent for Form VA 21-526? Children: VA recognizes biological children, adopted children, and stepchildren as dependents. But these children must be UNMARRIED and: under the age of 18, or be at least 18 but under 23 years old and pursuing an approved course of education, or have become permanently unable to support themselves before reaching the age of 18. 22
VA Form 21-527 Use if a veteran is filing a new pension claim or, If a veteran had previously filed for a VA disability compensation benefit. 23
VA Form 21-534 Use VA Form 21-534 if applicant is applying for a Death Pension Benefit. VA Death Pension Benefit is for widows or widowers that have not remarried, and dependent children. 24
VA Form 21-534 Use VA Form 21-534 if applicant is a dependent of deceased wartime veteran that includes: Surviving spouses who are single Surviving children who are unmarried and are under 18, or in school and under 23, or are incapable of self support before the age of 18. 25
VA Form 21-535 Use this form to apply for Parents Dependency & Indemnity Compensation benefit. Use this form when applicants are the parent or parents of a veteran who died from: A disease or injury incurred or was aggravated while on active duty, or active duty training; or A disease or injury incurred or was aggravated while on inactive duty for training; or A service-connected disability. 26
VA Form 21-4138 Use when the applicant is a veteran who is already receiving a VA benefit and needs to request an increase to that benefit based on the medical need for assisted living care. 27
VA Form 21-4142 The applicant s physician must fill out this form. Physician will explain why the applicant needs assisted living services. 28
Tips for Filling Out Forms Fill in all the spaces of the pertinent sections with data. If no data or answer is available or applies fill in box with N/A for not applicable 0, the number zero Unknown 29
Resident Signature Resident must sign the application. If resident incapable of writing, the resident can mark the application with an X and then application needs two witness signatures. 30
Important Tip Provide as much supporting documentation as is available. VA recommends submitting form without full documentation because benefit is paid retroactively to date VA office receives application in the mail or online. 31
Applicants with Dementia VA will appoint a fiduciary (third party payee) for any VA beneficiary who is a minor, or adult who is found to be unable to manage his or her own financial affairs (incompetency). Incompetency is determined by the Court or by VA disability rating. VA supervises the fiduciary to ensure that the beneficiary is protected. 32
How to Overcome Obstacles Physician understands importance of giving health information that supports need for placement in ALF. This needs to be relayed prior to completion of form (s) to avoid denial of pension. Contact VA with any unusual circumstances to get accurate answers on how to proceed, i.e. resident was married to two veterans, sequentially, who are now deceased. 33
Free Application Assistance Application assistance is free through VA county, state, and regional VA offices. Veterans service organizations offer free application assistance as well. Federal law prohibits any agency, corporation, or entity from charging to help an individual apply for a VA benefit. Fees can be charged to appeal a VA determination of a VA benefit. 34
State Veterans Affairs Offices Can help complete claim forms, answer questions, act as a claims representative. To Reach a State Veterans Affairs Office, or Veterans Services Organizations visit www.va.gov, Click on Partners. 35
Veterans Service Organizations Provide free application assistance to veterans Examples: AmVets, VFW, PVA, The American Legion, American Red Cross, etc. Check local telephone directory under Veterans Organizations. 36
Verify Veterans Services Organizations Visit VA General Counsel s Web page for list of VA approved organizations allowed to help applicants fill out forms for VA benefits: www1.va.gov/ogc/docs/bulletin23s.doc. 37
Submitting Applications Make a photocopy of the application and the supporting documentation. Applications can be submitted online: www.vabenefits.vba.va.gov/vonapp/main.asp Mail the application to the nearest VA regional office. You can find the closest VA office in the local telephone book or visit the Veterans Benefit Administration Web page www.vba.va.gov/benefits/address.htm. 38
VA Phone To locate nearest office or to be directed to nearest office. Call the VA at: (800) 827-1000 39