Medical Expenses Must Exceed Income to Qualify?

Discussion in 'General Discussion' started by Marp, Aug 7, 2011.

  1. Marp

    Marp Jr. Member

    My mom & I are working on the A & A for my dad. According to official information from the VA, if my parents countable income is less than the a set amount ($1949 for a married veteran), then they could be eligible for a benefit that makes up the difference between their countable income and the $1949. Thus, if their countable income is $500, they could be eligible for around $1400 in benefits. This would depend upon the amount of assets they have, their life expectancy, etc.

    Three people we've talked to, an Elderlaw attorney certified by the VA, the director of an ALF with experience helping with the A & A, and the owner of an in home care agency experienced with A & A, indicate this is not true. It's what the VA publicizes, but it's not what they do. According to the attorney, he "throws the statutes out when dealing with the VA because the VA doesn't pay attention to them anyway."

    What these three have told us is that my parents will not qualify for ANY award until their medical expenses exceed their income, thus they need a negative countable income. Since my parents have $500 in positive countable income, they would not, under any circumstances, qualify for any A & A, according to these people.

    According to official VA documents, they could qualify for a partial benefit that could be as much as $1400, depending on what the VA figures their life expectancy to be and how long the VA figures their assets might last.

    Has anyone else been told medical expenses must exceed income to qualify for A & A? Has anyone ever received a partial benefit when their medical expenses didn't exceed income?

    Just wondering.
  2. vetadmin

    vetadmin Administrator Staff Member

    You indicate that you and your mom are working on A&A for your dad. If your mom at this time does not require the care of others and assistance with her day-to-day living. My first question would be, why have all three of these folks given you the $1949 figure? This is for both a veteran and spouse who require care. A veteran alone is eligible for $1632 a month.

    A partial award is an option, but that is dependent upon the medical expenses, and the age does factor in. When a veteran applies they do have to disclose any and all income earned by both and not just the veteran's income.

    The best case scenario is that "countable" income is zero or negative after backing out all allowable expenses. You should look at the "Tips and Resouces" tab on this forum for a formula to help you arrive at what that figure is.
  3. Marp

    Marp Jr. Member

    First, these people are quoting us the $1949 from the VA "Federal Benefits for Veterans" which says that a "Veteran needing regular aid and attendance, one dependent" could be eligible for $23,396 per year. That comes out to $1949 a month. Nothing I have found indicates that the spouse (dependent) must also be in need of A & A for the $1949 to apply.

    The Elderlaw attorney we spoke with has 8 years experience assisting people file for the A & A benefit and averages 12 applications per month so he's dealt with this quite a bit and has probably worked with families where the veteran needs A & A, but the spouse doesn't.

    Where do you get your information that both the spouse and the veteran must need A & A in order for the $1949 benefit to apply? I've only had one other person tell me that but then she admitted she didn't really know much about the benefit.

    Second, as I indicated in my original post, the problem isn't understanding the published calculations; it's that we've been told the VA ignores that and does whatever they want to, regardless of what they've published or what the law says. I'm wondering if anyone here is in a situation similar to ours - one where we would qualify for a partial benefit, if the published information were used. I'm wondering if those people received a partial benefit or if they were denied because they didn't have a negative cash flow (medical expenses didn't exceed income).
  4. vetadmin

    vetadmin Administrator Staff Member

    You may want to verify with these folks that dollar amount is based on filing for a veteran or a veteran with spouse or "dependent child".

    If you file for a veteran and spouse you will have to provide a Physcian's Statement on your mom. If she does not require care, at the end of the first year, when the EVR is due, the VA will more than like demand in full the over payment be paid back.

    As the Founder of this website and forum, I do not hesitate to state, I believe you have been mis-informed.

    A single veteran, who served even one day during a qualified war time, may be eligible for up to $1,644.00 per month to help pay for home care, assisted living, nursing home care, and other medical necessities. A married veteran or a veteran with a dependent child may be eligible for up to $1,949.00 per month; a surviving spouse for up to $1,056.00 per month; and a veteran married to a veteran for up to $2,540.00 per month.

    There is also a lot of confusion out there about how much an individual can have in assets. There is NO SET ASSET CAP for everyone!! The amount that any claimant can have is dependent upon the claimant's total household gross income, total household out-of-pocket medical costs, and life expectancy.
  5. Marp

    Marp Jr. Member

    Thanks very much for your response. It appears, though, that some of the information you provide is contradictory (for space considerations, I've removed the parts that don't relate to the contradiction).

    In the first paragraph, you indicate the spouse must require care in order for my parents to be eligible for the $1949.

    In the second paragraph you state a married veteran may be eligible for the $1949. In this statement, there is no mention that the spouse need care; you only state that the veteran be married, which my dad is.

    In a nutshell, in one statement, you indicate the $1949 only applies to married veterans where the spouse also needs care but in the next you indicate the $1949 applies to a veteran who is married, with no mention of care needs for a spouse; there just has to be a spouse.

    Is this what you meant to say?

  6. vetadmin

    vetadmin Administrator Staff Member

    I don't write the VA regulations or select the wording that often times is confusing.

    Simple question:
    Does your mom require the services and attendance of another for her day-to-day living?

    If no, the application is for the veteran only, and he would be eligible for $1644 a month.
  7. Marp

    Marp Jr. Member

    If what you say is true, but VA wording is not "confusing"; it's downright wrong.

    I copied this right from the VA website:
    Example 1 MAPR Explanation
    Joe is a veteran of WW II. He has a spouse. He is entitled to aid & attendance. $23,396 Go to the A&A With One Dependent MAPR row.
    If Joe has deductible medical expenses, he can deduct any that exceed: $775 Go to the With One Dependent MAPR row and look at the To be deducted row beneath it.

    Example 2 MAPR Explanation
    Mary is a veteran of WWI. She has a spouse. She is entitled to aid & attendance. $23,396
    + 2,686
    $26,082 Go to the A&A With One Dependent MAPR row and add from the Early War Veteran row.
    If she has deductible medical expenses, she can deduct any that exceed: $812 Go to the With One Dependent MAPR row and look at the To be deducted row beneath it.

    The MAPR is reduced for each dollar of income that the veteran, surviving spouse, child, or their families have.

    These examples clearly state that a married veteran could be eligible for $1949, regardless of care needs of the spouse.

    I also copied this from the U.S. code 38:521:

    c) If the veteran is married and living with or
    reasonably contributing to the support of such
    veteran’s spouse, or if there is a child of the veteran
    in the custody of the veteran or to whose
    support the veteran is reasonably contributing,
    pension shall be paid to the veteran at the annual
    rate of $4,651, unless the veteran is entitled
    to pension at the rate provided by subsection
    (d)(2), (e), or (f) of this section.

    The dollar amounts are outdated, but, as far as I can tell, the explanation of a spouse has not. Thus, the fact that my dad is married & his income is the primary support for his wife, would indicate he would be eligible for the higher pension amount.

    Furthermore, the VA requires we include my mother's income (she doesn't have much, but some) in the countable income used to determine eligibility for this benefit. If they're going to use her income in the calculation, they sure as shooting should include her presence in the calculation. Not that our federal government would care.

    I'll call the VA directly later and see what they say. Even if they decide $1644 is the maxiumum my dad can get, it's better than a kick in the pants and anything we get will be helpful.

  8. Marp

    Marp Jr. Member

    Oh yea, and we've gotten off the topic of my original question:

    Do medical expenses have to exceed countable income before the VA will pay anything? Official VA publications (and I believe we agree on this) indicate the answer is often, "No." If the veteran's income falls below an established dollar figure ($1644 or $1949, whichever applies), he may be eligible for a benefit, if all else applies. However, other knowledgeable people I've spoken with say the VA ignores all of that and refuses to pay anything until the veteran has a negative cash flow - medical expenses are more than income.

    Has anyone received a benefit when they did NOT have the negative cash flow. In other words, did you receive some type of benefit when your medical expenses were less than your income?

  9. vetadmin

    vetadmin Administrator Staff Member

    The VA has sat on this pension for over 60 years while millions have missed out and continue to do so.

    This pension is for a lack of a better way of putting it, is a veteran's welfare program. It is inteneded to help offset costs so that proper care and services can be afforded.

    The VA makes no bones about not being in the business of protecting assets, and are not going to pay anymore than the guidelines allow for. Any monies between spouses is considered as it is reasonable that spouses take care of one another, and it is a source of income coming in every month to pay living expenses.

    What most veterans are not aware of is the fact the VA classifies a veteran the day they turn 65 as permanetly and totally disabled. That classification is what makes the veteran eligible at 65 for the Basic level of this pension as well as the other two including A&A. You don't see anywhere where the VA claifies that distinction. Most 65-yr olds do not consider themselves "disabled".

    Let me know how that phone call to the VA goes. Keep in mind calling on Mon or Tues is not the best time to try, and better later in the day rather that mornings.
  10. Fit2009

    Fit2009 Sr. Member

    Hi Guys,
    I think this will clarify it - since it is a veteran with a spouse, we are talking about a maximum benefit of $1,949. Since his wife is independent, you cannot deduct any facility fees associated with her, but $1,949 minus any positive income after deducting the medical expenses from income will give you the approximate award amount. Married people are always looking at either $1,949 or $1,291 depending on if the veteran or both need assistance (1,949) or just the non-veteran spouse ($1,291). Confusing because I know Debbie has had to help people out of a pickle who move into IL when one is not in need of assistance, so I think you guys just got off track.
  11. tvelin

    tvelin Newbie

    Wow. Thought I had this figured out. Now confused again. Read all the posts and still need clarification on the first question! Must medical/assisted care and attendance expenses exceed "Countable Income". If they don't, is the amount of positive "Countable Income" deducted from the potential benefit???
    Appreciate clarity on this. Thanx
  12. Marp

    Marp Jr. Member

    According to the manager at our county Veterans Administration, this is basically correct. She did say that the VA considers life expectancy of the claimant and dependents as well as how much they have in assets when determining an award so the actual amount awarded may differ a bit from what that calculation comes out to. It all comes down to if and how soon the claimant will run out of money.

    Maybe others have some additional insights to share.

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