Page Reviewed / Updated - Feb. 2014
VA Health Care is a medical benefits program offered to all veterans with 24 months of continuous active duty military service and a discharge status other than Bad Conduct or Dishonorable.
During enrollment, each veteran is placed in a Priority Group of 1 - 8. Placement into Priority Groups is dependent on a large number of factors including: length & dates of service, discharge status, service-connected disabilities, financial assets, income and other factors.
A veteran’s Priority Group determines the level of care offered. However, the availability of VA resources also plays a role in determining what care is offered. Due to the complexity of the Priority Groups and the ever-changing availability of VA resources, it is nearly impossible for veterans to determine the long term care services for which they qualify and the fees for those services without speaking directly with the VA on a case-by-case basis.
Veterans must go through a complex eligibility evaluation to receive benefits and often the hard and fast rules change based on the availability of resources. Therefore it is important to check with the VA or a veterans’ benefits consultant.
During enrollment in VA Health Care, veterans are assigned into different Priority Groups. A veteran’s disabilities, especially those connected to their service, are one of the primary factors in the assignment. Therefore veterans are not required to have a disability, but having a disability plays a very large role in determining which benefits a veteran receives and how much those benefits cost.
A veteran’s financial resources are only considered if they have been assigned to a higher number (but lower priority) Priority Group. Higher Priority Group assignment generally means they do not have disabilities resulting from their military service.
Resources are defined as the sum of the veteran and their spouse liquid and fixed assets and their income minus their allowances, such as medical bills. Veterans having resources in excess of the maximums are evaluated case by case to determine their need.
A very general rule of thumb is veterans can have up to $80,000 in resources or up to $30,000 in annual income. Married veterans can deduct $100,000 from their total resources as “spousal resource protection”. However, veterans should not make decisions based on these numbers, there are many exceptions and these amounts change based on the veteran’s county of residence. Veterans with resources beyond the maximum allowable amounts here should consult directly with the VA to determine if they are eligible.
Veterans are required to have 24 months of continuous active duty military service and a discharge status other than Bad Conduct or Dishonorable to be eligible for VA Health Care. There are exceptions to the 24 month rule for:
The veteran’s geographic location does not affect eligibility directly but the maximum allowable amount of resources changes depending on the county in which the veteran resides.
Age and marital status do not impact eligibility for VA Health Care.
VA Health Care benefits are made in the form of medical care, personal care and payments to medical providers. VA Health Care does not provide cash to veteran seniors. Benefits limits range dramatically depending on the veteran’s Priority Group. For long term care, co-pays can range from $0 - $100 / day. Veterans with a compensable service-connected disability are exempt from long-term care co-pays. Although the VA has made significant improvements in their claims processing backlog, application decisions can still take many months.
The VA offers Assisted Living care through the Community Residential Care Program (CRCP) and at VA Domiciliaries. However, for the majority of veterans, the VA only pays for this program’s administration and clinical services. Care is provided both VA facilities and at approved outside facilities. There are also specialized dementia and Alzheimer’s care programs. Veterans should also be aware of the VA Aid and Attendance Program which provides financial assistance to help pay for assisted living.
VA offers skilled nursing care at VA nursing homes, State Veterans home and outside homes when the VA or State homes are not available in locations that would allow the veteran to remain close to their family. Skilled nursing home care is available under two programs. If the care is considered temporary, it is referred to as Community Living Center Care or if care is for longer term, it is called Community Nursing Home Care. Veteran seniors must be assessed by a medical provider and determined to require inpatient nursing care and be medically stable. Payment for care varies dramatically depending on the veteran’s Priority Group.
Some veterans that have been approved to receive skilled nursing care can receive that care at home through the VA’s Homemaker and Home Health Aide program. This is an attractive options for many families should they have someone at home that can provide the necessary supervisor in the absence of the VA interdisciplinary treatment team. As with all VA health care services, cost vary dramatically depending on the veteran’s priority group.
Adult Day Care
Adult Day Health Care programs offer supervision of veteran seniors during daytime hours when the family of the veteran is at work. This is also an attractive option as it allows the senior to remain living at home. Costs vary dramatically depending on the veteran’s priority group.
Veterans should be aware of an alternative program that enables them to direct their own health and personal care instead of receiving care services from the VA. This program is known as Veterans Directed Home and Community Based Services. The VA also provides hospice and Palliative care.
There are no costs to enroll or monthly premiums. However, some veterans are responsible for co-pays.
Many veterans find assistance with the application is necessary. Guidebooks are available. Veterans can also call the VA’s Health Benefits Service Center; toll free at 877-222-VETS (8387).
Veterans can apply for VA long term senior care by completing VA Form 10-10EZ. Veterans without service-connected disabilities or with 0% service-connected disabilities will also need to complete VA Form 10-10EC. This is used to measure the veteran’s and family’s current income and assets to determine if they will be charged co-pays for long term care. The VA has a “duty to assist” applicants in the collection of supporting documents, however veterans can greatly accelerate the process by providing these documents themselves.