HEALTH CARE: INCOME-TESTED HEALTH ASSISTANCE FOR VETERANS WITH NONSERVICE-CONNECTED HEALTH NEEDS1 BASIC PROGRAM INFORMATION LEGISLATIVE OBJECTIVE.-To provide a broad spectrum of health services for veterans with both service-connected and non-serviceconnected health problems. DATE ENACTED AND MAJOR CHANGES.- The program was first enacted in 1930. The present law was enacted in 1958. Major amendments in 1962 provided for the following: (1) Hospital care to any veteran in need because of a service-connected disability (this eliminated the requirement of wartime service); (2) outpatient medical services needed because of service-connected disabilities; and (3) an end to State attachments of assets from estates of deceased veterans residing in State homes to offset against cost of such care. Major amendments in 1970 provided that: (1) Hospital services may be furnished to any veteran over age 65 for a non-service-connected disability; (2) medical services for a non-service-connected disability may be furnished where a veteran of any war has a total disability permanent in nature from a service-connected disability; and (3) any veteran in receipt of a VA pension is exempt from making any statement under oath regarding his inability to defray necessary expenses. Public Law 93-82 (1974) expanded care to include outpatient medical services to any veteran eligible for hospital care under VA law where such care is reasonably necessary to prevent hospital admission. This law also provides for hospital and medical care for the wife or child of a totally and permanently disabled service-connected veteran and to surviving widows and children of veterans who died as a result of service-connected disability (unless care is provided under CHAMPUS or medicare). In the case of veterans who are at least 80 percent service-connected disabled, outpatient care is provided for any disability requiring treatment. The bill also extends mental health services, consultation, professional counseling and training to members of the immediate family of a disabled veteran and such home health services as may be necessary or appropriate for the effective and economical treatment of a VA beneficiary. It also places peacetime veterans on the same basis as wartime veterans for hospital and In addition to the medical and related services provided to veterans with a service-connected disability, the VA provides services to persons with non-service-connected health needs in order to maintain fuller utilization of its facilities. In this section only non-service-connected health services will be considered as income maintenance-related. Specific programs included in this section are as follows: (1) Community nursing home care; (2) domiciliary care and restoration; (3) hospitalization; (4) nursing home care; (5) outpatient care; (6) prescription services; (7) prosthetic appliances; (8) State domiciliary care; (9) State nursing home care; and (10) State hospital care. medical benefits. Public Law 93-82 also authorizes reimbursement of hospital care and medical services rendered to veterans who have service-connected disabilities when there is a medical emergency and VA or other Federal facilities are not available. This law also provides specific authority for a VA program of screening, counseling, and treatment of sickle cell anemia. ADMINISTERING AGENCY.-The programs are administered by the Veterans Administration, Department of Medicine and Surgery. FINANCING. The programs are financed under closed-end appropriations by Federal payments under contract, under grants, and for direct operational costs. Costs 1 1 Includes expenditures on service-connected health care needs. In calendar year 1973 approximately $1.4 billion was spent for 813,000 veterans receiving care for non-service-connected health problems. This amounts to more than half the total spending for veterans' medical care. There were 29 million living veterans in June 1973. ELIGIBILITY CRITERIA MAJOR ELIGIBILITY CONDITIONS.-The following types of veterans, released or discharged from service under conditions other than dishonorable, are eligible for the services listed-generally on a space available basis. The types of veterans are listed in approximate order of descending priority for services. Veterans with service-connected disability and non-service-connected medical needs may receive: Prehospitalization, hospitalization, posthospitalization, prosthetic devices and nursing home care for medically determined needs; Domiciliary care (the veteran must be able to function without assistance) when suffering from a permanent disability or tuberculosis or neuropsychiatric ailment and if incapacitated from earning a living and has no adequate means of support (this generally means less than $265 per month income from any source); Nursing home care for persons attaining maximum hospital benefit, or no longer requiring domiciliary care; Medical services while receiving hospitalization or non-serviceconnected disabilities; Outpatient care for non-service-connected disability provided the veteran has a permanent and total service-connected disability or the veteran is receiving or is eligible to receive increased compensation based on the need for regular aid and attendance or by reason of being permanently housebound; Medical services on an outpatient basis to any veteran eligible for hospital care under VÂ laws, where such care is reasonably necessary to prevent the need for hospital admission. These services may include medical examinations and treatment, optometrists' services, dental and surgical services, prehospital and posthospital treatment in connection with the treatment received while hospitalized; Prescribed drugs and medicine as part of authorized hospital or outpatient care, and other prescriptions ordered by private doctor if the person is receiving additional compensation, allowance, or pension because he is housebound or needs regular aid and attendance; and Transportation services. Veterans of any war, or of service after January 31, 1955, with nonservice-connected disabilities for which they swear that they cannot defray medical expenses are eligible for the following: Prehospital, hospital, posthospital, nursing home or domiciliary care, transportation services, and prosthetic devices when there is a medically determined need for such; Medical services while receiving hospitalization for non-serviceconnected disabilities; and Prescribed drugs and medicine as part of authorized hospital or outpatient care. Veterans over 65 years of age or in receipt of a VA pension are eligible for the following: Hospital, pre- and post-hospital nursing home, domiciliary care, prosthetic devices, and transportation when there is a medically determined need for such services (these veterans are not required to state under oath that they are unable to defray the costs of such care); Outpatient treatment and prescriptions where the aged veteran is a person who served in the active military or naval service during the Spanish-American War or Indian wars, or receives or is eligible for an increased pension based on the need for regular aid and attendance or by reason of being permanently housebound; and Prescribed drugs and medicine as part of authorized hospital or outpatient care, and other prescriptions ordered by a private doctor if the person is receiving an additional pension because he is housebound or in need of regular aid and attendance. PERSONS INCLUDED.-Eligible veterans are included in the programs. Their dependents or survivors are not included. INCOME TEST Income limits. For nursing home care, domiciliary and, restoration center care, and hospitalization there are variable income limits. A statement under oath that a veteran cannot defray necessary medical expenses (or without an oath for those receiving pensions) establishes the income limit for hospitalization, outpatient care, and nursing home care for any veteran of war or of service after January 31, 1955, for a non-service-connected disability. The income limit for domiciliary care and restoration for persons suffering permanent disability, tuberculosis, or a neuropsychiatric ailment where the person is incapacitated from earning a living is $265 per month when the veteran has been discharged or released for a disability incurred or aggravated in the line of duty or where a person is in receipt of compensation for a service-connected disability. A veteran who qualifies under any of the above provisions also qualifies for prosthetic appliances. A veteran receiving aid and attendance whose pension has been reduced will continue to get prescription service if his income is no more than $500 over the income limit for the pension. Definition of income.-For domiciliary care, total income from all sources is considered. For prescription services, treatment of income. is the same as for non-service-connected disability pensions. Treatment of earned/unearned income.-All income regardless of source is considered in determining ability to pay for care; this determination is very informal in most cases. Accounting period. For domiciliary care the period over which care is needed is considered. For prescription services the accounting period is the same as for non-service-connected disability pensions. ASSETS TEST.-There is no assets test for veterans with serviceconnected disabilities. In other cases an assets test is applicable to the extent that for hospitalization, domiciliary, and restoration center care, nursing home care, and prosthetic appliances, the veteran (except for a veteran over age 65 and veterans receiving pension payments) must sign a poverty oath stating that he is unable to defray expenses. The determination by the VA on whether the estate of a veteran should be used to defray expenses is based on: (1) Income; (2) ease with which the estate may be converted to cash; (3) limitations imposed by community property laws; (4) life expectancy of the veteran; (5) number of dependents; and (6) the potential rate of depletion of resources of the veteran. The estate is defined as all real or personal property, except the veteran's dwelling, a reasonable lot, and personal effects. OTHER CONDITIONS Acceptance of training or rehabilitation.-No acceptance is required, but training and rehabilitation are available to the veteran. Community nursing home and domiciliary care provide rehabilitation in preparing veterans for return to the community. Citizenship. There is no requirement. BENEFITS AND SERVICES NATURE OF BENEFITS.-In-kind benefits provide hospital care, domiciliary and restoration center care, nursing home care, outpatient care (including dental care services), prescription services, and prosthetic appliances, as specified above under major eligibility conditions. Services are provided through VA facilities (166 hospitals, 202 outpatient clinics, and 85 domiciliaries, restoration centers, or nursing care units) and through hometown medical care programs. Under hometown medical care programs the VA provides payments on a fee basis to physicians and dentists who treat eligible veterans in their hometown area. (Fee basis care is not available to all veterans but is authorized on an individual basis, taking into consideration distance from a VA facility and type and urgency of care required.) In addition, State-run facilities for domiciliary and restoration center care, nursing home care, and hospital care may receive VA grants to provide services to eligible veterans. Treatment for drug addiction and alcoholism is provided in special units in some VA hospitals, clinics, and restoration centers. Determinants of benefit amounts.-The value of the benefit is the cost of the same medical aid provided on the open market. There is no limitation imposed on the duration of hospitalization, except that a veteran will be transferred to a nursing home facility when hospitalization is no longer necessary. The maximum period for contract nursing home care is 6 months but may be extended by the administrator if he determines it is necessary. There is no time limit in a VA or State nursing home. Relationship to place of residence.-The utilization of some services may be constrained by the availability of a VA facility. OTHER SERVICES PROVIDED OR AVAILABLE.-Rehabilitation programs are available through restoration centers and community nursing home facilities. Outpatient services provide a wide range of social services. Placement in a foster home is also available. 46-032 0-75 -15 |