Filing a claim can be time-consuming and complicated. It’s important to get help.
Applications for Pension that involve a rating, evidence of prospective, recurring medical expenses, appointments for VA powers of attorney and fiduciaries, and an understanding of the actual application process should not be attempted without prior knowledge. We recommend you purchase our book to avoid lengthy delays in a decision or possible denials of the claim. Not only does the book help you understand how to shorten the decision process from VA and ensure a successful claim but the support forms we provide also help you present medical evidence and costs in a format familiar to VA service representatives. Applications that also involve reallocation of assets in order to qualify should not be attempted without the help of a qualified veterans aid and attendance benefit consultant.
Annualizing Costs of Assisted living, Residential Care, Adult Day Care or Other Similar Arrangements
These facilities are not categorized by VA as nursing homes. As such, annualization of costs and a rating are not automatic. If the beneficiary is not rated, the service representative will only allow recurring unreimbursed medical expenses for specific medical care provided by licensed health professionals. Costs for room and board or custodial care cannot be applied.
For information on ratings please go to the article entitled “Who is eligible for the aid and attendance Pension benefit?”
On the other hand, if a beneficiary residing in one of these living arrangements has been rated a need for “aid and attendance” or “housebound”, VA will allow all reasonable costs to be counted as prospective, annualized medical expenses as long as some of those costs are paid for medical care. The providers do not have to be licensed. In the case of Alzheimer’s, the physician’s statement used for rating must indicate the person needing care must be in a protective environment; otherwise, only medical costs are covered. Applying for a rating is discussed in a previous section above. All reasonable costs would include room and board as well as other unreimbursed billable services.
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 director of the facility must sign a statement verifying the type of care being given and the fact that the person receiving the care is expected to remain a resident in the facility. We have included in our book, a copy of a form entitled “Form 2 — Care Provider Report (used to provide evidence of recurring medical expenses)” We highly recommend this form or a similar form be submitted with the application. A copy of the contract for services as well as invoices and statements from the facility should also be included with Form 2.
There may be a possibility of a non-veteran spouse of a living veteran receiving annualized credit for recurring costs of non-nursing home facility care. Requesting annualization for the spouse may be a problem because the amount of allowable costs without a rating for “aid and attendance” or “housebound” could be much smaller or disallowed. We recommend checking the box on the application for a rating. This will probably confuse the service representative but may alert that person to the request of the spouse’s expenses. We also recommend submitting a letter with the application requesting recurring, annualized treatment of the cost of the care facility and assuring VA the spouse does deserve a rating. Otherwise, the spouse’s cost of assisted living may not be allowed as a deduction.
VA will not allow a Pension rating for a non-veteran spouse of a living veteran, but the point is to try and convince the service representative that the total cost of room and board should be annualized as if there were a rating. All of the corroborating evidence such as medical reports, statements, verification reports by directors of the facilities, and contracts should be submitted in the same manner as if applying for these benefits for the veteran. We cannot assure any applicant that this request will be granted, but it is worth a try. We recommend you contact a qualified aid and attendance benefit consultant to help you with this special case scenario of a non-veteran spouse.
Of course, a death claim is different because the surviving spouse can receive a rating in that case. If VA allows annualization of facility costs for a spouse of a living veteran, there will be no Pension allowance for aid and attendance or housebound, and the Pension award will be much smaller.