Veterans Eligibility for VA Nursing Home Care
The VA may pay all or part of the nursing home costs for disabled and elderly veterans.
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The Department of Veterans Affairs (VA) provides both short-term and long-term care in nursing homes to veterans who aren’t sick enough to be in the hospital but are too disabled or elderly to take care of themselves. Priority is given to veterans with service-connected disabilities.
The VA is required to provide nursing home care to any veteran who:
- needs nursing home care because of a service-connected disability
- has a combined disability rating of 70% or more, or
- has a disability rating of at least 60% and is:
- deemed unemployable, or
- has been rated permanently and totally disabled.
Other veterans in need of nursing care will be provided services if resources are available after the above groups are taken care of.
Types of Nursing Care Available
Community Living Centers. Some VA Medical Centers have Community Living Centers (these used to be called Nursing Home Care Units or VA Nursing Homes). These centers are typically located within the VA Medical Center itself or in a separate building.
Contract Nursing Home Care. Nursing home care in public or private nursing homes is also available to some veterans. Stays in these nursing homes can be limited, however, for veterans with ratings less than 70% and for veterans who do not need care due to a service-connected disability.
State Veterans Homes. State Veterans Homes are nursing homes run by the state and approved by the VA. Sometimes the VA will pay for part of the care a veteran gets at a state veterans’ home.
Eligibility for Community Living Centers (CLCs)
To receive care in a Community Living Center/VA nursing home, a veteran must:
- be enrolled in the VA Health Care System
- be psychiatrically and medically stable
- provide documentation specifying whether short or long-term care is needed, an estimation of how long the stay will be, and when discharge will occur, and
- show priority for a stay in a CLC.
However, meeting the above criteria does not automatically ensure admission. CLCs make decisions about whether to admit a veteran based on the following factors:
- availability services in the CLC
- what sort of care the veteran needs, and
- whether the CLC can competently provide the type of care the veteran needs.
Veterans required to make co-pays are typically those:
- without a service-connected disability rated at least 10%, and
- whose income is higher than the VA's maximum annual pension rate.
How to Apply for CLC Care
Typically a veteran’s physician will submit the application requesting care in a CLC. Veterans who are not exempt from co-pays must complete VA Form 10-10EC, Application for Extended Care Services.
Eligibility for Contract Nursing Home Care
Any veteran who needs Contract Nursing Home Care for a service-connected disability or is receiving VA home health care after discharge from a VA hospital is eligible for direct admission. To be admitted, all that is required is for a VA physician or authorized private physician to determine that nursing home care is needed. Veterans rated 70% or more service-connected should also be eligible.
Other veterans are eligible to be transferred into Contract Nursing Home Care (also called a Community Nursing Home) if the VA determines the care is needed and:
- the veteran is in a VA hospital, nursing home, domiciliary, or has been receiving VA outpatient care, or
- an active member of the Armed Forces who was in a DOD hospital, needs nursing care, and will be an eligible veteran upon discharge.
Time Limits for Contract Nursing Home Care
Veterans who are not in the priority groups are technically limited to six months of care, but this may be reduced to 30 to 60 days if resources are limited. Veterans in the priority groups are technically entitled to unlimited free care, but again may receive shorter stays due to a lack of funding and resources to accommodate them.
Many veterans can extend their stay by relying on payments from Medicare and Medicaid.
How to Apply for Contract Nursing Home Care
Typically application will be made by a veterans’ doctor, social worker or nurse, using VA Form 10-0415, Geriatrics and Extended Care (GEC) Referral.
Eligibility for State Veterans Homes
In some cases, the VA will help pay for a veteran’s care at a State Veterans Home. The payments the VA will make are called per diem aid. A home must meet the VA standards for nursing home care to receive per diem aid. In addition, the VA will not pay more than half the cost of the veteran’s care.
State homes provide hospital care, nursing home care, domiciliary care, and sometimes adult day care. To receive per diem aid, veterans must meet VA eligibility requirements for the type of care they will receive.
States usually have their own eligibility requirements, in addition to the VA's requirements, such as residency requirements. The veterans home will apply for VA aid for a veteran's care by submitting VA Form 10-10EZ, Application for Medical Benefits.
The VA will pay per diem aid for a veteran’s care indefinitely.
Reduction in VA Pension
A veteran who begins to receive nursing home care will have his or her monthly pension payment reduced to $90 if:
- the veteran has no dependents
- the veteran is living in a Medicaid-approved nursing facility, and
- the nursing home care is paid for by Medicaid.