The Veteran Directed Care (VDC) program, previously called the Veterans Directed Home and Community Based Services (VD-HCBS) program, is designed to allow veterans who are potential candidates for nursing home placement to receive that level of care in their homes, their caregivers’ homes, or in non-supportive, independent living communities (not assisted living residences). The program provides veterans with a budget and allows them to choose their own care providers in place of receiving care services from the VA health care system. In some cases, family members of the veteran can be paid for the care they provide.
This program is referred to by many names, such as Cash and Counseling for Veterans, Veterans Community Living Program, CLP-VDHCBS, Veterans Independence Plus Program and Veteran Directed Home Services (VDHS)
Veteran Directed Care allows veterans to prioritize their own care needs, select their own care providers, and act as an employer instead of receiving nursing home care from the VA directly. (If a veteran cannot direct his or her own care, a representative may be authorized to do so in place of the veteran). The program started in 2008 and has been working toward making it available nationwide. Currently, VA Medical Centers in 42 states, as well as D.C. and Puerto Rico, have referred veterans to the Veteran Directed Care Program.
Surveys of program participants show that 95%+ of participating veterans found this program was meeting their needs, improving their overall satisfaction, and improved their access to care. Having said that, these programs are not appropriate for everyone. A substantial amount of effort is required of the veteran and their family in the determination of care requirements, selection of providers, and ongoing management of the care services. However, for many families, the independence to choose care providers, the potential to pay family members for their assistance, and the ability for the veteran to continue living at home make participation in this program well worth the effort.
1) The veteran, working with family members, and usually an advisor from the state, develops a “Care Plan” outlining the services, supports, supplies, and estimated budget for the veteran to live at home or in the community instead of a nursing home. The name “Care Plan” or “Participant Spending Plan” changes from state to state, but the concept is the same.
2) The veteran submits his or her Care Plan for approval to the administering agency. The plan is reviewed and any required modifications are agreed upon through a collaborative back-and-forth process. In conclusion, a spending budget is established for the veteran.
3) The veteran hires and schedules all care providers, services providers, and necessary supplies. (For veterans who do not have the cognitive capacity to take on this role, an authorized representative may do so.) It is very common for veterans to hire family members, including their spouse, neighbor or friend to provide them with personal care. Hired care providers are expected to pay taxes for the wages received.
4) The administering agency provides a Financial Management Service (FMS) that pays for care and issues checks to the service providers and/or reimbursement for goods purchased with pre-approval. Payments made to care and service providers are authorized by both the veteran and the FMS.
Vets cannot participate in VDC and in a Medicaid Cash and Counseling program concurrently.
An important distinction between the VDC program and Medicaid’s Cash and Counseling program is that in the VDC program, participants have a budget and the ability to authorize payments to their care providers. However, they do not personally receive cash from the program, as is the case with most Cash and Counseling programs. These two programs are mutually exclusive. Therefore, a veteran cannot participate in both VDC and in a Medicaid Cash and Counseling program concurrently. Medicaid Cash and Counseling programs are also referred to as Consumer Directed Medicaid Waivers.
The Veterans Directed Care program is open to all U.S. Veterans enrolled in the VA health care system who require a nursing home level of care. These programs are at various stages of development in different states, and often participation requirements change as a program matures. What follows are the typical requirements. It is recommended that the applicant check with their local Area Agency on Aging to determine final eligibility.
Age – The VDC Program is open to veterans of any age.
Disabilities / Health Requirements – Veterans are eligible provided they require nursing home level care. However, there are multiple factors and exceptions associated with this requirement. Typically, individuals requiring assistance with three or more activities of daily living are eligible. These restrictions are less rigid for those veterans over 75 years of age, or who are clinically depressed, or receiving hospice care, or live alone. A diagnosis of Alzheimer’s alone does not make an individual eligible, but the care requirements of most individuals with moderate to advanced Alzheimer’s will make them eligible.
Marital Status – A veteran’s marital or family status does not make them ineligible for participation in this program. However, individuals that live alone may experience less rigid requirements.
Residential Location – Veterans must live at home, in the home of a loved one, or in an independent living residence (which does not offer care support). They cannot reside in a nursing home or assisted living community.
Financial – The program does not have specific income and asset limits. However, participants must be enrolled in VA Health Care and assigned to a Priority Group and some Priority Group benefits are impacted by one’s income and assets. Aid and Attendance payments are not considered a factor when determining the amount of a veteran’s care budget in the VDC Program.
Veteran Service and Discharge – veterans are required to have had 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:
Geographic – As of September 2022, there are programs in the 42 states listed below, plus Washington, D.C. and Puerto Rico. While not all geographic areas within these states have coverage, veterans are permitted to travel from their home area to participate in a VDC program. Also, many other states are in the process of approving pilot programs. If one’s state is not listed below, the candidate should check with their local Area Agency on Aging to see if a program is in development in their geographic area.
These programs are administered at the VA Medical Center-level, and veterans are free to choose to receive assistance from whichever VA Medical Center they prefer. Therefore, veterans can go outside of their immediate geographic area or to neighboring states to participate in a veteran-directed care program.
States with VDC Programs (updated September 2022)
8. District of Columbia
25. New Hampshire
26. New Jersey
27. New Mexico
28. New York
29. North Carolina
34. Puerto Rico
35. South Carolina
36. South Dakota
VDC programs will pay for a very wide range of services and goods. Any product or service that is required for the participant’s care, health maintenance, or improves the participant’s ability to live independently will usually be covered by the program. Participants receive a monthly budget to use for their personal care and relevant supplies in place of receiving the same from the VA Health Care system. To be clear, the veteran authorizes the agency to pay service providers on his or her behalf, but does not personally receive the cash payments.
The option to pay any family member to provide caregiving assistance is probably the single most attractive benefit of veteran directed care. To be clear, the adult children, siblings, grandchildren, and even the veteran’s spouse can be hired and paid as caregivers. Of course, caregivers must be physically and mentally capable of providing the care for which they will be compensated.
Caregivers are paid an hourly rate set nationally by the Veterans Health Administration and adjusted for local geographic factors. The hourly rate is referred to as the “reimbursement rate,” and caregivers can expect compensation in the range of 50-75% of the average hourly rate for home care for their region. In very general terms, this may be between $8 – $21 / hour.
The following is a list of products and services that are typically paid for under this program:
While the range of goods and services that the VDC program will pay for is extensive, certain costs are not covered. These include:
The monthly budget allocated for a veteran’s care depends on his or her individual requirements, which are determined during the development of the Care Plan. The maximum amount allowed varies from state to state. Typically, the cost of this care cannot exceed the cost for the same care if it were provided by the VA in a skilled nursing facility. In real dollar terms, budget maximums rarely exceed $4,500 / month.
Participants should expect several months for the preparation and approval of a Care Plan prior to actually receiving care services. The process can be accelerated if a participant begins the hiring process for care providers after submitting his or her Care Plan while waiting for its approval. However, no payments can be made until the Care Plan has been approved.
Veterans do not incur any costs to participate in the program.