Need help directing Veteran and his wife

[snuffysmith]

I am a Social Worker and have been trying to help a couple get A & A.  The Veteran has advanced COPD and is basically housebound, except for doctor's appointments.  The wife also has advanced COPD, is housebound, and worse off.  Our VA Services Officer suggested applying through the husband, because the benefits would be higher.  We believed A & A would provide a cash pension that they could use to hire caregivers, as they are barely getting by and an adult son is helping out as best he can for now.  The were denied because they have slightly too much income.  Then our VA Services Officer retired.  One who is helping out one day/week while they rehire told us that medical expenses (caregiver expenses) would bring their income down enough to qualify.  They haven't hired anyone because they can't afford to and this is why they are applying for A & A.  It seems if they hired someone, then they would have receipts to bring down their income and possibly get approved.  This seems like a Catch 22.  Another VA Services Officer told me he thought it would be very very difficult to get this approved and the couple was more likely to get help from Medicaid. But he did suggest filling out a medical expense statement with projected expenses that reflect what it WOULD cost them if they could afford to hire.  Does anyone ever get approved applying this way?  I don't want to get their hopes up.  The couple has this decision to make and I don't know what to tell them.  Also, if they get approved for Medicaid and the state pays for caregivers, can they ever go back for A & A?  We are in Oregon, by the way.  Thanks so much in advance.

[vetadmin]

It is a catch-22 situation. 

You have to have medical expenses to claim.  You should look at the "coutable income" tab here on the forums to determine what figure.

They do not need to appeal, all they would have to do is complete a 21-4138 Statement of Support of Claim showing any new information for reconsideration.  The VA does not work off of projected expenses.  That comes into play with the EVR, which is sent out the year after they would be awarded.  There you can estimate the following year's cost along with actual costs.

They do have to be paying someone whether that be the son, or outside services coming in.  Ideally if they are at zero or negative at the end of the month, they would qualify financially and physically.

If they file for Medicaid, they can't have both the state and the VA paying their expenses.  If they go on Medicaid, the most he could draw would be $90.00 a month, and that money cannot be spend on medical.  It has to be used for personal items.

If there is anyway they can try to bring that income down, it would be best.

Thanks for trying to help them.