Research - Rehabilitation - Re-Employment

Sgt. Shaft 01/13/2003

Dear Sgt. Shaft,
I am a federal employee faced with the decision of whether to sign up my husband for the long-term care insurance now offered to federal employees. Since he is a Vietnam veteran, a 4 1/2 year POW, and receives service-connected 60% disability for one condition and 100% for another, will he qualify for care at a Veterans facility if needed in future years? I don't want to purchase this costly insurance if it is not necessary. I am asking you because I saw your piece in the Washington Times dated June 24, 2002. That seems to indicate that veterans, such as my husband, do not need to purchase long-term care insurance. But I don't want to make the mistake of misinterpreting what you said. Thanks so much for your help.

Rosemary C. Arlington, VA

Dear Rosemary:
Based on the information that you provided, it seems your husband is eligible for a myriad of benefits including long term care. The Veterans Millennium Health Care and Benefits Act, which enhances the medical benefits package introduced by Eligibility Reform, extended long-term care benefits to provide a range of possible services, including nursing home care, domiciliary care, adult day health care, geriatric evaluation, and respite care.

VA attempts to provide a customized treatment plan for the veteran who is eligible for long-term care. Care may be provided at a VA medical facility, through VA contracted health care services, or by referral to a community provider at the veteran's expense. Veterans should not give up their current health care plans, even if they are enrolled and are eligible for long-term health care benefits.

Here's a brief rundown on long-term care coverage provided for in the Act.

Any veteran who has a service-connected disability rated at 70 percent or more qualifies for nursing home care. Veterans whose service-connected disability is clinically determined to require nursing home care also qualify. Care will be provided in a VA nursing home or contract nursing home (about 10% of the country's nursing homes have VA contracts). The VA may provide nursing home care to other veterans if space and resources are available. Nonservice-connected veterans and zero percent, non-compensable, service-connected veterans requiring nursing home care for any nonservice-connected disability must complete a means test or extended care co-payment exemption test to determine whether they will be billed for nursing home care. Most veterans are not eligible for reimbursement or direct placement in private nursing homes.

Domiciliary care may be provided to veterans whose annual income does not exceed the maximum annual rate of VA pension or to veterans the Secretary of Veterans Affairs determines have no adequate means of support. Domiciliary care provides rehabilitative and long-term, health-maintenance care for veterans who require some medical care, but who do not require all the services provided in nursing homes. Domiciliary care emphasizes rehabilitative and return-to-the-community settings.

The Adult Day Health Care (ADHC) program is a therapeutic day care program that provides medical and rehabilitation services to disabled veterans in a congregate setting. ADHC is part of the basic benefits package. Veterans need to be enrolled in VA for their health care and meet the clinical admission criteria for ADHC.

Geriatric evaluation is the comprehensive assessment of a veteran's ability to care for him/herself, the individual's physical health, and the social environment designed to develop a plan for care. The plan could include treatment, rehabilitation, health promotion, and social services. These evaluations are performed in inpatient Geriatric Evaluation and Management (GEM) units, GEM clinics, geriatric primary care clinics, and other outpatient settings.

Respite care provides supportive care to veterans on a short-term basis to give the caregiver a planned period of relief from the physical and emotional demands associated with providing care. Prior to the new changes, respite care was limited to VA nursing home care or hospital beds. Now, respite care can be provided in the home or at other non-institutional settings.

Skilled home care is provided by the VA and by contract agencies to veterans who are homebound with chronic diseases as well as to patients with a terminal illness. Hospice/palliative care programs offer pain management, symptom control, and other medical services to terminally ill veterans or veterans in the late stages or chronic disease process, as well as bereavement counseling and respite care to their families.

The maximum co-payment rates that can be charged for long-term care services are:

• Nursing home, inpatient geriatric evaluation, and inpatient respite care, $97/day 
• Adult day health care, outpatient geriatric evaluation, and outpatient respite care, $15/day 
• Domiciliary care: $5/day

Veterans with a compensable service-connected disability are exempt from long-term care co-payments. Nonservice-connected veterans and non-compensable zero percent service-connected veterans may be subject to a long-term care co-payment and must complete a means test or long-term care co-payment exemption test when applying for long-term care services. The long-term care co-payment exemption test, like the means test, is a measure of the family's income and assets for the previous 12 months. Some veterans may then be required to complete an Application for Extended Care Services, VA Form 10-10EC, which is a measure of the family's current income and assets.

However, the calculated monthly co-payment amounts will vary from veteran to veteran and is based on financial information submitted on VA Form 10-10EC. Once completed, the VA can calculate the monthly long-term care co-payment amount using current income and assets of the veteran and spouse, monthly expenses and a monthly allowance for non-covered expenses for both the veteran and spouse. A Social Worker or Case Manager assigned to assist in the veteran's placement in long-term care will provide the veteran with a projected monthly long-term care co-payment amount for the following 12-month period.

Persons wanting more information about eligibility for these benefits should either call toll-free at 1-877-222-VETS (1-877-222-8387) or visit the VA's Internet at www.va.gov/health/elig.

Send letters to Sgt. Shaft, c/o John Fales, P.O. Box 65900, Washington, D.C. 20035-5900; fax to 301-622-3330; call 202-462-4430 or email sgtshaft@bavf.org.

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