Many long-term care facility and in-home care provider companies have been fronting the cost, or a portion of the cost, of veteran residents pending an Aid and Attendance pension benefit.  Providers that defer payment while a veteran or their spouse transition to long-term care could be setting veterans up for failure.

VA pension benefits are need based. The VA allows for a deduction from the claimant’s income for recurring prospective medical expenses, such as rent in an assisted living facility or in-home care costs. These expenses are annualized from the day the veteran becomes a claimant. If the claimant’s income, after deductions, is less than the guaranteed minimum income level published (and the rest of the elements of qualification are met), the VA will grant benefits in the amount that brings their income up to the minimum. If the claimant’s income after deductions is negative the claimant qualifies for the maximum benefit.*

For this reason fronting the cost of care and other medical expenses can derail a veteran’s claim for Aid & Attendance pension.

For example:

John is a veteran that is now needing assistance with his daily routine.  He moves into an assisted living facility on the premise that he will be awarded an Aid & Attendance pension benefit.  The facility agrees to or offers to defer his payment until he is awarded his back pay and monthly benefit.  Four months into this agreement the VA adjudicator calls the assisted living facility to verify that the veteran is indeed receiving care and incurring the medical expenses stated in John’s claim. The person who answers the phone at the assisted living facility states that he is not currently paying rent (or paying at a lesser amount than what was reported) because that is what the facility’s records show. The VA then either denies the claim or sends out a letter asking for clarification. Unfortunately, this will likely cause John to be ineligible for a full 12 months even if he starts paying monthly once he realizes that this deferment disqualifies him. This is because the VA will annualize the medical expenses. He would only have 8 months of medical expenses in a 12 month period.

This can be avoided by making sure that no deferment agreement is in place for the claimant.

*Center For Elder Veteran Rights