Monthly Archives: September 2019

What Is Survivors Pension with Aid and Attendance?

September 3, 2019

August 20, 2019 | by the National Care Planning Council

Survivor’s Pension – also known as Death Pension – is a disability income program available to the single surviving spouse and/or dependent children of a deceased veteran who served during a period of war.

Eligibility requirements for the deceased veteran include active duty service for at least 90 days – with one of those days during a period of war – and an honorable discharge or a discharge classified as other than dishonorable. Service in combat is not required. For deceased veterans of the Gulf War, the service requirement is 24 months or completion of the requirement for active duty service, whichever comes first.

Here is the Period of War chart for benefit purposes:

Period of War Beginning and Ending Dates
World War 2 December 7, 1941 through December 31, 1946
Korean Conflict June 27, 1950 through January 31, 1955
Vietnam Era August 5, 1964 through May 7, 1975; for veterans who served “in country” before August 5, 1964, February 28, 1961 through May 7, 1975
Gulf War August 2, 1990 through a date to be set by law or Presidential Proclamation

Definition of Surviving Spouse and Rules Pertaining to Application

The rules pertaining to application for Survivor’s Pension for a single surviving spouse – who was married to a veteran– are very much the same as the rules pertaining to application for Pension for a living veteran. There are, however, some minor but very important differences.

The single surviving spouse can be any age and does not have to be permanently and totally disabled prior to age 65. The veteran, who died, did not have to be totally disabled if death occurred before age 65. The veteran who died does have to qualify based on active duty service days as well as serving during a period of war.

Application should not be made unless it is certain that the surviving spouse meets the rules to be a surviving spouse. All of these following conditions must apply or the surviving spouse is not eligible for Death Pension:

  1. The surviving spouse must have met the conditions to be married under VA rules. Generally this means a marriage lasting at least one year or a child was born as a result of the marriage regardless of the length of time married. Under certain conditions, VA will also accept common-law marriages or marriages where the couple held themselves out to be married and can prove that was their intent.
  2. The surviving spouse must have lived continuously with the veteran while they were married unless they were separated due to the fault of the veteran. Evidence regarding such a separation will be required.
  3. The surviving spouse must have been married to the veteran when the veteran died. Divorcing the veteran while the veteran was alive bars any entitlement to this benefit.
  4. The surviving spouse cannot have remarried after the veteran ‘s death even if the surviving spouse is currently single. There is one exception to this rule. If the surviving spouse remarried after the veteran’s death and that marriage has been terminated either through death or divorce prior to November 1 of 1990 and the surviving spouse has since remained single, that person can still receive the benefit.

2019 Maximum Annual Survivor ‘s Pension Rates (MAPR)
Effective December 1, 2018 – 2.8% COLA Increase

If you are a surviving spouse…  

Annual

Monthly

MAPR Without Dependent Child

$9,078

$756

No dependents, medical expenses must exceed 5% of MAPR

$453

$38

MAPR With One Dependent Child

$11,881

$990

With dependents, medical expenses must exceed 5% of MAPR

$594

$50

Housebound Without Dependents

$11,095

$924

Housebound With One Dependent

$13,893

$1,157

A&A Without Dependents

$14,509

$1,209

A&A Without Dependents (SAW Veteran’s Surviving Spouse)

$15,097

$1,258

A&A With One Dependent

$17,309

$1,442

A&A With One Dependent (SAW Veteran’s Surviving Spouse)

$17,833

$1,486

SBP/MIW Annuity Limitation

$9,078

$756

Add for Each Additional Child

$2,313

$192

MAPR FOR CHILD ALONE

$2,313

$192

Child Earned Income Exclusion effective 1/1/2000

$7,200

$600

The Rating for Aid and Attendance

A Rating Allows for Special Deductions and Additional Income Allowances VA will provide additional income in the form of an allowance on top of the basic Survivor’s Pension benefit of $9078/year or $756/month if the widow has a regular medical (care) need for assistance or a need for supervision due to disability. This is sometimes called “Improved Survivor’s Pension” or “Survivor’s Pension with an allowance.”

A medical need for assistance or supervision due to disability is, in most cases, crucial to getting the Survivor’s Pension benefit or not getting it.  A so-called “rating” from VA recognizes either the regular need for aid and attendance from another entity or the condition of being housebound. This rating, determined by a doctor’s examination is determined from VA Form 21-2680, and allows certain medical and care expenses and ancillary non-medical expenses to be subtracted or deducted from future income.

A “rating” also increases the allowable Survivor’s Pension rate as seen above in the MAPR Chart. For example, a surviving spouse with no rating is only eligible for basic Survivor’s Pension, up to $756/month. If the same surviving spouse becomes unhealthy and proves a need for the ongoing aid and care of another individual, he or she would be eligible for up to $1209/month.

Except for very poor households, most widows could not get the Survivor’s Pension benefit without this special rating provision for the deduction of personal care and medical-related expenses simply because their income is too high.

The high cost of medical and medical-related expenses associated with long term care such as home care, assisted living or nursing home care are usually the main deductible expenses VA counts when calculating the benefit. A surviving spouse, for example, who is paying $3,000/month for care at assisted living and has income of $2,800/month would qualify for the full Survivor’s Pension benefit with the aid and attendance allowance of $1209/month IF that surviving spouse was “rated” for the need of aid and attendance of another person.

Unfortunately, very few of all eligible surviving spouses are actually receiving Survivor’s Pension. Most do not know of the benefit nor this special deduction.

How Survivor’s Pension Is Calculated

For Surviving Spouses without an “Aid and Attendance or Housebound Rating”,

VA calculates Survivor’s Pension Benefits as follows:

  1. Gross Household Income – Income Exclusions – Certain Ongoing Medical Expenses = Income for VA Purposes (IVAP). We will discuss Medical Expenses and IVAP below.
    Then,

2.  Applicable MAPR – (IVAP + 5% deductible) = Actual Benefit

For Surviving Spouses with an “Aid and Attendance or Housebound Rating”  VA calculates Survivor’s Pension Benefits as follows:

1.  Gross Household Income – Income Exclusions – Income Exclusions – Most         Ongoing Medical Expenses = Income for VA Purposes (IVAP). We will discuss Medical Expenses and IVAP below. Then,

2.  Applicable MAPR – (IVAP + 5% deductible) = Actual Benefit

The Net Worth Limit

The net worth limit for Pension or Survivor Pension entitlement is $127,061 for effective dates of payment starting December 1, 2018 through November 30, 2019. This limit is increased by the same percentage as the COLA in Social Security benefits each year on December 1 of each year and will parallel Medicaid’s Community Spousal Resource Allowance (CSRA). The divisor for calculating the penalty period to be used for 2019 is $2,230 a month.

Definition of Net Worth and the Bright Line Test Effective

October 18, 2018, the Department of Veterans Affairs (VA), changed the net worth criteria for Pension claims. Net Worth on or after October 18, 2018 is the sum of a claimant’s:

  • assets

PLUS

  • income for VA purposes (IVAP), including the income of a spouse and dependent children under certain circumstances

Please note when IVAP is a negative number, it is to be considered zero dollars. As a result, assets cannot be further reduced by negative income. Net worth can only be reduced to the extent that there is no income to add to the assets and thus if IVAP is zero, the net worth is the value of the assets alone. Also, the IVAP calculation is based on an initial application for Pension. This means that only reasonably predictable medical expenses can be subtracted from household gross income such as recurring insurance premiums, the recurring cost of paying caregivers or care services and possibility the recurring cost of renting medical devices.

Income for net worth purposes includes the income of the claimant and spouse or the income of a single surviving spouse.

Defining Assets

Assets are the fair market value of all property that an individual owns, including all real and personal property, unless excluded under 38 CFR 3.275(b). If the total value of an annuity or similar financial instrument is used when calculating the asset amount, VA does not include the monthly income derived from the same annuity or similar financial instrument when calculating income for net worth. This would result in double counting for calculating net worth.

Fair market value is the price at which an asset would change hands between a willing buyer and seller. VA will use the best available information to determine fair market value, such as inspections, appraisals, public records, and the market value of similar property. Fair market value is determined based on valuations at the time of application.

The following are rules for asset inclusion for net worth:

  • If the claimant is a veteran then the veteran’s assets include the assets of the veteran as well as the assets of his or her spouse.
  • If the claimant is a surviving spouse, the assets include only the assets of the surviving spouse.
  • If the claimant is a surviving child and he or she has no custodian or is in the custody of an institution, the child’s assets include only the assets of the child.
  • If a surviving child has a custodian other than an institution, the child’s assets include the assets of the child as well as the assets of the custodian. If the child is in the joint custody of his or her natural or adoptive parent and a stepparent, the child’s assets also include the assets of the stepparent.
  • VA will not consider a child to be a veteran’s or surviving spouse’s dependent child for Pension purposes if the child’s net worth exceeds the net worth limit.

The total value of an annuity, trust or other similar financial instrument is counted as an asset if the claimant establishes that he or she has the ability to liquidate the entire balance. For example, if the entire asset is locked up in an irrevocable trust and unavailable, it is not an asset. Likewise if an income annuity is income only and has no feature to get to the original purchase amount, it is not an asset. Other such arrangements as limited partnerships, private stock or an installment sale would likely not have an option to sell or liquidate and as a result would also not be counted as assets.

If the claimant cannot liquidate the value of the annuity, trust or other similar financial instrument or information about the liquidity of an annuity is unavailable, VA counts the monthly income received as income for net worth purposes and excludes the financial instrument value from assets. The same would be true of any other financial arrangement that locks up the asset but produces income.

What Type of Burial Assistance Does the Government Provide?

September 3, 2019

August 20, 2019 | by the National Care Planning Council

General Observations

Death and dying are issues typically overseen by the states. There are very few federal programs to help with burial as compared with numerous federal programs for eldercare. Only when death is a consequence of participation in a federal program is it covered. For example, assistance for burial is covered by Social Security, the Department of Veterans Affairs for veterans, the Department of Defense for military and some minimal support from Medicaid through Medicaid matching funds for states.

States, counties and cities themselves typically offer little assistance for burial unless the deceased is indigent and no funds can be found to pay for cremation or burial. And in many states, the only indigent people who are covered are those who die and the body remains unclaimed. In these cases, local county governments have no recourse but to cover the cost of a cremation. There are some exceptions to this general practice of no support with some states, but over the years more and more states have opted out of programs to help families with burial costs.

By and large, responsibility for funerals and burial or cremation rests with the family. It is therefore very important when planning for the final years of life to have money set aside or available for death. We will discuss below a number of community support options for those who do not prepare. In general, very few community or government assistance programs will pay for a burial. Cremation is generally the rule. A funeral service is optional for the family but typically not paid for with assistance funds.

Social Security Death Benefit

You may receive a one-time payment of $255 when a family member dies, depending on your relationship to them and how long they have worked. Generally, only surviving spouses and children of deceased workers qualify for the one-time death benefit. In addition, the deceased family member must have worked long enough to be insured under Social Security, but it doesn’t matter if they were already collecting Social Security or not.

The death benefit payment is made to the surviving spouse living with the deceased person at the time he or she passed, or if there is no surviving spouse, the payment is made to a child of the deceased person. Spouses who are not living together when one spouse dies may still receive the death benefit if they were eligible for benefits on the deceased spouse’s earnings in the month the spouse passed. If there is no surviving spouse or child who qualifies for the payment, then no payment will be made.

This is a one-time, lump sum benefit; however some survivors may qualify for a monthly benefit in addition to the one-time death benefit. You must apply for the lump-sum death benefit within two years of the family member’s death.

In addition to the one-time payment, certain family members may receive a monthly benefit for a deceased person. For widows or widowers without dependents, this amounts to receiving the larger of the two social security benefits if both were receiving benefits or receiving the deceased person’s benefits if the survivor was not receiving any. The following family members may qualify for Social Security survivor benefits:

  • a widow or widower, beginning at age 50 if disabled or 60 is not disabled;
  • a widow or widower who is caring for your child under the age of 16, regardless of the age of the widow or widower,
  • unmarried children of the deceased also qualify if they are under age 18 (or age 22 if they are disabled).
  • in some cases, even grandchildren, step children or adopted children may qualify for survivor benefits.

If you are divorced, you may qualify for survivor benefits on an ex-spouse if you were married for at least 10 years, and you are age 60 or older when your ex-spouse passes (you only need to be age 50 if you are disabled).

You should notify Social Security and apply for Social Security benefits right away after a family member has passed. To do so, you can call the Social Security Administration or visit the closest office to you. You will need to provide proof of death (death certificate or proof from a funeral home), your Social Security number and your deceased family member’s Social Security number, your birth certificate, marriage certificate if married, divorce papers if you are divorced, and income information for the deceased family member (from W-2s or income tax returns) for the most recent year

Veterans Death Benefits

These monetary benefits are for veterans who were receiving disability income from either Disability Compensation or Veterans Pension.

SERVICE CONNECTED DEATH

$2,000

NON-SERVICE CONNECTED DEATH (Reimbursement; veteran dies while hospitalized by VA)

$762.00

NON-SERVICE CONNECTED DEATH (Reimbursement for Veterans not hospitalized by VA)

$300.00

NSC DEATH STATE CEMETERY (Paid to a state veterans cemetery for the plot/burial)

$762.00

NSC DEATH PLOT ALLOWANCE (This amount will be paid to reimburse for a private-paid plot)

$762.00

A service-connected death is one where the veteran was receiving monthly payments for Disability Compensation and the death was due to the disability or condition for which the veteran was receiving pay. It is also possible to receive a service-connected death if the disability or condition was not the direct cause but the disability or condition contributed substantially to the death.

A non-service-connected death is one where the veteran was receiving monthly payments for Disability Compensation or Veterans Pension but the death was due to some other cause not related to the disabilities or conditions for which the veteran was receiving pay.

It should be noted that generally a non-service-connected death can produce $1,062 a month if the survivors have to pay for a funeral plot. Note that if the veteran died while hospitalized by VA and the survivor has to pay for a funeral plot the total amount available is $1,524.

Disaster Associated Burial Benefit

The most tragic disaster-related loss imaginable is that of a loved one. Under the Individuals and Households Program’s (IHP) Other Needs Assistance (ONA) provision, an applicant may qualify for certain eligible funeral expenses.

FEMA Funeral Assistance is provided to help with the cost of unexpected and uninsured expenses associated with the death of an immediate family member when attributed to an event that is declared to be a major disaster or emergency.

Eligible funeral expenses may include:

  • Cost of casket
  • Mortuary services
  • Transportation of the deceased and/or up to two family members into the area to identify the decedent (if required by state/local authorities)
  • Two Death Certificates
  • Burial plot
  • Interment or cremation
  • Cost of re-interment if disinterment is a) caused by the declared disaster, and b) occurs in a family cemetery on private property
  • Eligibility Criteria

Typically, federal and state personnel at the FEMA Joint Field Office review the supporting documentation from the applicant and payments are approved by the Federal Coordinating Officer (FCO) or designee and his/her state counterpart.

To be eligible for funeral assistance, applicants must provide:

  • A death certificate for the decedent
  • Documentation from a designated, authoritative state or local entity (attending physician, Medical Examiner’s office, or Coroner’s Office as appropriate) that attributes death or the injury causing death to the declared emergency or major disaster
  • Proof that the applicant is the official “next of kin” as defined by the appropriate state or local authority
  • Confirmation that funeral expenses have not been paid for by other resources (Social Security and Veterans Affairs benefits, for example, would duplicate Funeral Assistance and would be subtracted from an award)
  • Evidence of an unmet funeral expense (a receipt from a service provider)
  • Ineligible Costs

Not all applicants reporting funeral expenses will be eligible for Funeral Assistance. Some common reasons for ineligibility include:

  • The death was not attributed to the declared incident
  • Funeral expenses are fully covered by other sources of assistance
  • Insufficient and/or incomplete documentation
  • If disinterment was the result of the disaster, FEMA will provide Funeral Assistance only for a disinterred coffin under the following conditions:
  • The unearthed coffin(s) were located in a family cemetery on their private property
  • The coffin(s) were removed from the ground by the declared disaster

Private Sector and Community Programs

There are a number of ways where the private sector and certain community groups or church denominations will help cover a burial and possibly a funeral.

Taxpayer Interment Benefits

Local taxpayers in many cities and counties qualify for reduced interment costs in cemeteries.

Church Members and Members of Civic Organizations Benefits

Church members and members of civic and other organizations may qualify for funeral assistance or for reduced costs. Some church denominations will also provide burial for their members in the church cemetery. This is principally for Greek Orthodox, Jewish and Catholic faiths but may include other faiths as well.

Crime Victims’ Compensation Fund

A Crime Victims’ Fund often provides funeral benefits in instances of death by a criminal act. There are many crime victim funds across the United States. Most are funded by the state or county. Ask the prosecutor’s office in your area or do a computer search using the name of your county or city and the term “crime victim fund”.

Death Benefits from Pensions, Societies and Other Organizations

Organizations affiliated with some professions, such as the Railroad Retirement Board, as well as some social groups, unions and pensions, offer allowances to defray funeral costs. Some organizations and pension funds include an automatic group life insurance policy on their members. This may include unions and other fraternal organizations as well as veterans service organizations. These may be small amounts of coverage such as $1,000, but adding up benefits from a number of sources might produce enough for a burial or cremation. Here are some examples of funds that will defray costs.

  • Workman’s compensation, if death was work-related,
  • Civil service (federal, state, county or local) retirement pension fund,
  • Federal Employees Life Insurance (Includes a lifetime benefit even after retirement)
  • Railroad fund,
  • Teacher’s fund,
  • Miner’s benefits fund,
  • Trade union fund,
  • Credit union fund,
  • Fraternal organizations fund.

Discounts or Gratis Services from Funeral Homes

For families who simply cannot come up with enough money to bury a loved one, funeral homes may be surprisingly accommodating. Even though they may not advertise it, funeral homes may offer charity for a number of people in the community when no other way to bury a loved one is possible. This might include steep discounts, extended monthly payment plans, extremely affordable economy plans and possibly even providing the burial — in this case very likely a cremation — for free.

Government Pays for Only about 16% of Long Term Care

September 3, 2019

April 2, 2019 | by the National Care Planning Council

Government programs such as Medicare, Medicaid and the Veterans Administration will cover the cost of long-term care under certain conditions. Medicare will cover rehabilitation from a hospital stay or limited care at home if there is a skilled need. The Veterans Administration will cover the cost of nursing home care if the veteran is at least 70% service-connected disabled. The VA will also cover other forms of home-based or community-based care if there is a medical need.

Medicaid will cover both medical and non-medical related long-term care but in order to qualify for Medicaid a person has to have less than $2,000 in assets in most states and income that is insufficient to pay the cost of care. In other words a person must be impoverished. Otherwise Medicaid will not pay.

Government literature and government websites claim that state and federal governments pay a large proportion of long term care costs in this country. That is only true because the majority of long-term care services are provided free of cost. In order to understand the private versus government burden for long-term care we need to look at the actual hours of care provided and not the cost.

Based on our analysis of yearly, one-on-one care hours, we estimate that about 84% of all long-term care is not covered by government programs. Conversely, this means only 16% of long term care service hours are covered by the government. The 84% that is not covered is primarily family-provided home care to help with activities of daily living, or help with maintaining a home, providing meals and support, or care services providing supervision or companionship or providing transportation and shopping services. Care costs not covered by the government are also care provided from family out-of-pocket payments in nursing homes and assisted living facilities. Families are also hiring more and more private services to help with care at home.

Based on the charts below about 71% of all long-term care hours are provided in the home by family. (We have excluded home care hours from Medicaid and Medicare programs.) . Most of this care is provided free of charge by family members, friends or volunteers. However some is provided by professionals or aides paid from family funds or from insurance. Some care is also paid for privately for assisted living and nursing homes as well. If we were to multiply the total number of care hours we derived for the chart below times the average hourly cost for what private aides would provide, we would have a rough equivalent yearly cost of family-provided and family-funded care in this country. We estimate about 16,556,400,000 hours per year of care hours in 2000 (it is difficult to find current figures). The number of elderly has grown about 1% per year since then. This gives us roughly 19,221,000 hours currently. We use a cost of private health aides at $25 an hour.

Multiplying the two figures together gives us about $480.5 billion of equivalent, current family-provided care cost. This is roughly 3 times the total current amount the state and federal government pay yearly for all long-term care services. If the Federal government alone had to pay all home care costs in this country combined with what it already pays for long-term care, the cost would be the third largest single expenditure in the federal budget exceeded only by Social Security and defense.

Many people are pushing the government to do just that – pay an increasing amount of home care services for the elderly.

Reports Find Hospice Deficiencies Go Unaddressed

September 3, 2019

Hospice care is supposed to help terminally ill patients maintain their quality of life at the end of their life, but two new government reports find that serious problems in some hospices may be actually causing harm to hospice patients. The reports propose that additional safeguards are needed.

Medicare provides a comprehensive hospice benefit that covers any care that is reasonable and necessary for easing the course of a terminal illness. Most hospice care is provided in the home or in a nursing home. State agencies or private contractors survey hospices to make sure they comply with federal regulations. If a hospice fails to meet a standard, the surveyor cites the hospice with a deficiency.

A pair of reports by the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) found that from 2012 through 2016, more than 80 percent of hospices surveyed had at least one deficiency and one in five had a deficiency serious enough to harm patients. About 300 hospices were identified as “poor performers” and 40 had a history of serious deficiencies.

The reports found that the most common types of deficiencies involved poor care planning, mismanagement of aide services, and inadequate assessments of beneficiaries. Some of the most serious problems that were found included a beneficiary who developed pressure ulcers on both heels, which worsened and developed into gangrene, requiring amputation of one leg. Another beneficiary developed maggots around his feeding tube insertion site. Both of these beneficiaries had to be hospitalized, which hospice is meant to prevent.

Meanwhile, the OIG found that it is hard for consumers to learn about which hospices are doing a good job. The Centers for Medicare and Medicaid Services (CMS) launched the Hospice Compare website in 2017, but the site does not include information from the surveyors’ reports. Hospices also do not have as strong reporting requirements as nursing homes. In addition, CMS has limited ability to discipline hospices other than to drop the hospice from Medicare.

The reports provide a number of recommendations to CMS to improve monitoring of hospices, including the following:

  • Expanding the data that surveying organizations report to CMS and using these data to strengthen its oversight of hospices
  • Taking steps to include the survey reports on Hospice Compare
  • Educating hospices about common deficiencies and those that pose particular risks to beneficiaries
  • Increasing oversight of hospices with a history of serious deficiencies
  • Strengthening requirements for hospices to report abuse, neglect, and other harm
  • Ensuring that hospices are educating their staff to recognize signs of abuse, neglect, and other harm
  • Improving and making user-friendly the process for beneficiaries and caregivers to make complaints.

To read the OIG reports, click here and here.

For National Public Radio’s coverage of the reports, click here.

Medicaid’s Gift to Children Who Help Parents Postpone Nursing Home Care

September 3, 2019

In most states, transferring your house to your children (or someone else) may lead to a Medicaid penalty period, which would make you ineligible for Medicaid for a period of time. However, there are circumstances in which transferring a house will not result in a penalty period.

One of those circumstances is if the Medicaid applicant transfers the house to a “caretaker child.”  This is defined as a child of the applicant who lived in the house for at least two years prior to the applicant’s entering a nursing home and who during that period provided care that allowed the applicant to avoid a nursing home stay.  In such cases, the Medicaid applicant may freely transfer a home to the child without triggering a transfer penalty.  Note that the exception applies only to a child, not a grandchild or other relative.

Each state Medicaid agency has its own rules for proof that the child has lived with the parent and provided the necessary level of care, making it doubly important to consult with your attorney before making this (or any other) kind of transfer.

Others to whom a home may be transferred without Medicaid’s usual penalty are:

  • Your spouse
  • A child who is under age 21 or who is blind or disabled
  • Into a trust for the sole benefit of a disabled individual under age 65 (even if the trust is for the benefit of the Medicaid applicant, under certain circumstances)
  • A sibling who has lived in the home during the year preceding the applicant’s institutionalization and who already holds an equity interest in the home