Independent Living Applicants for VA Benefits in Jeopardy after recent VA Clarification Letter

Independent Living Applicants for VA Benefits in Jeopardy after recent VA Clarification Letter

The Department of Veterans Affairs (VA) recently issued a letter of clarification indicating that room and board paid to an independent living facility should not be considered as a deductible unreimbursed medical expense in most cases.

One of the most important eligibility requirements in getting VA improved pension benefits (often referred to as Aid and Attendance – which is available to wartime veterans who were not dishonorably discharged or to his or her surviving spouse if they meet certain financial requirements) is to have enough unreimbursed medical expenses (to get the full benefit the unreimbursed medical expenses should exceed the applicant’s income). The VA benefit is usually between $1,000 to around $2,000 per month depending if it is the veteran is single, if the veteran has a dependent or if the applicant is the surviving spouse of a wartime veteran. The recent clarification letter from VA indicates that while room and board is a deductible medical expense if the applicant is in custodial care, only assisted living facilities and nursing homes are normally considered custodial care.  However, there have been inconsistent rulings on whether the cost of room and board at an independent living facility should be considered an unreimbursed medical expense (UME). The ruling does provide for some limited situations where an applicant can get can such benefits even if the applicant lives in an independent living facility. This is important since the greater the UME, the more likely the applicant will get benefits.

The letter of clarification indicates the only exceptions where the claimant can get such VA benefits while living in independent living are: (1) if the claimant’s physician states in writing that the claimant must live in the facility and separately contract for custodial care with a third party provider (not the independent living facility); (2) the facility provides custodial care and assists the claimant with two or more activities of daily living (bathing, dressing, eating, transferring such as getting in and out of a bed or chair, and using the toilet); or (3) if (1) and (2) above are inapplicable, then VA will not deduct room and board paid to the facility and will only allow a deduction of any medical or nursing services obtained from a third party provider.

Since room and board is often the largest portion of expenses at a senior or independent living facility, it is less likely that applicants will receive this VA benefit due to this letter of clarification.

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