By Robert Deschene, Esq

As a nation, we owe our veterans a huge debt of gratitude for their selfless service and sacrifice for our country.  It is truly a debt we can never fully repay.  What we must do is ensure that they receive the respect and dignity they deserve when it comes time for them to receive long-term care at the end of their lives.  For that reason, the government offers qualified veterans many forms of financial assistance, such as pensions, home loans, life insurance, and education grants (through the GI Bill).

What is Aid & Attendance?

One of the lesser known programs available to some wartime veterans is called Aid and Attendance (A&A), which is administered by the Veterans Administration (VA), and which assists elderly or disabled veterans (or their surviving spouses) pay for the costs of long-term care, whether in-home care or in an assisted living facility or nursing home.    A&A provides a veteran up to $1,758 in tax-free benefits per month to a veteran, $1,130 to a surviving spouse, or $2,085 to a couple.
Who qualifies?

To qualify for A&A, the veteran’s disability need not be service-related.   He or she must have served at least 90 days on active duty, one day of which was during a “time of war” (i.e., World War II, the Korean conflict, or the Vietnam or Gulf Wars), and not have received a dishonorable discharge.  (Until the President or Congress officially declares an end date, the Gulf War is considered ongoing.)  A surviving spouse must have been married to the veteran for at least one year, or had a child together and cohabited until the veteran died.

Limits on Assets

An applicant must provide a written evaluation from their doctor describing a medical condition which makes them unable to care for themselves (e.g., dressing, bathing, cooking, eating, leaving home), and must disclose his or her assets and income. Unlike Medicaid, which normally requires applicants to have less than $2,000 in assets to qualify for long-term care benefits, A&A has no fixed dollar cut-off for assets.   Instead, the question is a subjective one, evaluating whether the applicant has sufficient “net worth” to pay for his or her own medical expenses for the remainder of their lives.   Like Medicaid, A&A does not count the home, a vehicle or personal belongings as assets, but other assets – like savings accounts, investments, and retirement accounts – are considered.   The VA assesses each application on a case-by-case basis, looking at the applicant’s particular circumstances, such as income, other medical and non-medical expenses, and life expectancy.  While many elder law attorneys suggest capping your assets at $80,000, the subjective “net worth” standard makes it difficult to predict whether an A&A application will be approved.

If the applicant has too many assets, he or she might be able to transfer them to an irrevocable trust or to your children in order to qualify for A&A.  Note, however, that these transfers might disqualify you from other benefits, such as Medicaid, if you need to enter a nursing home within five years of the transfer.

Robert Deschene, Esq.

Limits on Income

An A&A applicant (or surviving spouse) also must have limted income.  A&A limits a veteran to about $21,000 in annual income, $13,500 for a surviving spouse, or $25,000 for a couple.  Countable income includes any earned income (like wages), but also unearned income such as investment income, annuities, pension, and Social Security.  You are then allowed to deduct from this gross income amount all unreimbursed medical expenses.   These would include the out-of-pocket cost of an assisted living facility or nursing home, home health services, health insurance or Medicare premiums, and the cost of prescriptions.

Approval of an A&A application may take several months, but payments will be made retroactively to the date of application.