Using Aid & Attendance for Professional Home Care

Annualization of Home Care Costs

Medical expenses for home care aides are allowed prospectively for annualization if those expenses are reasonably predictable. The evidence would also have to show that the need for care is ongoing and regular. Expenses may be allowed whether the care recipient has a rating for aid and attendance or housebound or is not rated. However, deductible payments to a non-rated beneficiary are more restrictive.

Evidence must be submitted indicating an ongoing need for the care and the level of care in order for the Veterans Service Representative to consider the medical expense as recurring and eligible to be annualized. A form such as the one we provide in our block entitled "Form 2 -- Care Provider Report (used to provide evidence of recurring medical expenses)" should be used for this purpose. Also a copy of a contract between the provider and the recipient, covering at least a year, and outlining the provisions and the cost should be submitted to prove the intent of the care recipient and the provider.
For an explanation of the special annualized treatment of unreimbursed long term care costs and insurance premiums please go to the article entitled "Understanding the special case of long term care medical costs".

The non-veteran spouse of a living veteran may also be eligible for annualization of home health aide costs. If the home care is being furnished by a licensed health professional, then not much further proof is necessary other than the documentation proving the care is being provided. If the provider is not licensed, a separate letter from the doctor must be produced that says the person needing care must be in a "protected environment."

VA will not rate a non-veteran spouse of a living veteran for "aid and attendance" or "housebound" and even though the spouse’s home care medical expenses may be annualized to produce a benefit, the Pension award will be much smaller without the allowance for a rating. Of course, a death claim is different because the surviving spouse can receive a rating in that case.

For information on ratings please go to the article entitled "Who is eligible for the aid and attendance Pension benefit?"

Home Care Recipient Is Not Rated

Payments for care at home for a recipient who is not rated for housebound, or aid and attendance are only allowed for annualization if made to a licensed health professional. The term "licensed health professional" refers to an individual licensed to furnish health services by the state in which the services are provided. The term includes registered nurses, licensed vocational nurses and licensed practical nurses. Some states also license non-medical home care providers to provide services as well. Since this is a fairly new practice, we don't know if these people would qualify under the definition above but we suspect they will.

All reasonable fees paid to the licensed health professional for personal care of the disabled person and maintenance of the disabled person's immediate environment may be allowed. This includes such services as cooking for the disabled person and housecleaning for the disabled person. It is not necessary to distinguish between "medical" and "nonmedical" services. However, services which are beyond the scope of personal care of the disabled person and maintenance of the disabled person's immediate environment may not be allowed.

Services beyond the scope might be services such as driving the veteran's spouse to appointments, paying bills, answering the phone, providing shopping errands for the household, and so on. If an hourly rate is being paid to the home care provider, a portion of this rate may be disallowed for services beyond the scope of personal care.

Care Recipient Is Rated for "Aid and Attendance" or "Housebound"

If the disabled care recipient has been rated "housebound" or in need of "aid and attendance" by VA, all fees paid to an in-home attendant will be allowed as long as the attendant provides some medical or nursing services for the disabled person. The attendant does not have to be a licensed health professional.

All reasonable fees paid to the individual for personal care of the disabled person and maintenance of the disabled person's immediate environment may be allowed. This includes such services as cooking for the disabled person and housecleaning for the disabled person. It is not necessary to distinguish between "medical" and "nonmedical" services. However, as with an unrated beneficiary, services which are beyond the scope of personal care of the disabled person and maintenance of the disabled person's immediate environment may not be allowed.

For a disabled person who has been rated, a family member may be considered an in-home attendant, but that family member has to be paid for services duly rendered. There is potential for fraud here where a family member may move into the home and ostensibly receive payment as a caregiver but not actually provide the level of care paid for. Documentation for this care must be provided to VA, and it is reasonable for VA to question whether the services being purchased from someone living in the household are legitimate.

Documentation of Home Care Expenses

If the fees for an in-home attendant are an allowable expense, receipts or other documentation of this expense are required. Documentation includes any of the following:

  1. a receipt bill
  2. statement on the provider’s letterhead
  3. computer summary
  4. ledger, orbank statement.

The evidence submitted must include:

  1. the amount paid
  2. the date payment was made
  3. the purpose of the payment (the nature of the product or service provided)
  4. the name of the person to or for whom the product or service was provided
  5. identification of the provider to whom payment was made.

 

Pension -- Maximum Annual Pension Rates (MAPR) 2016-17

These amounts increased by .3% on 12 / 01 / 2016

For a Living Veteran

 

Yearly

Monthly

Without Spouse or Child

 

$12,907

$1,075

Medical Deduction

 

$645

$54

With One Dependent

 

$16,902

$1,408

Medical Deduction

 

$845

$70

Housebound Without Dependents

 

$15,773

$1,314

Medical Deduction

 

$645

$54

Housebound With One Dependent

 

$19,770

$1,647

Medical Deduction

 

$645

$70

Aid and Attendance Without Dependents

 

$21,531

$1,794

Medical Deduction

 

$645

$54

Aid and Attendance With One Dependent

 

$25,525

$2,127

Medical Deduction

 

$845

$70

Add for Each Additional Child

 

$2,205

$183

 

Death Pension -- Maximum Annual Pension Rates (MAPR) 2016-17

For a Survivng Spouse

 

Yearly

Monthly

Without Dependent Child

 

$8,656

$721

Medical Deduction

 

$433

$36

With One Dependent Child

 

$11,330

$944

Medical Deduction

 

$566

$47

Housebound Without Dependents

 

$10,580

$881

Medical Deduction

 

$566

$47

Housebound With One Dependent

 

$13,249

$1,104

Medical Deduction

 

$566

$47

Aid and Attendance Without Dependents

 

$13,836

$1,153

Medical Deduction

 

$566

$36

Aid and Attendance With One Dependent

 

$16,506

$1,417

Medical Deduction

 

$566

$47

Add for Each Additional Child

 

$2,205

 

MAPR FOR CHILD ALONE

 

$2,205