Eligibility for Home and Community Based Services
Following is a summary of eligibility for Home and Community Based Services. For more information go to the Home and Community Based Services section of this Guide and see the eligibility section in each service, or visit https://iris.custhelp.com/app/home. You can also talk with your VA social worker/case manager about your eligibility for these services.
All Veterans enrolled in VA's health care system are eligible, as Home and Community Based Services are part of the VHA Medical Benefits Package. However, your eligibility is based on clinical need for the service and its availability. (Note that PACE is not a VA service and not part of the VHA Medical Benefits Package.)
Care must be ordered by a VA physician for Veterans who meet the clinical need for the service. Those having clinical need are Veterans who need skilled health care, case management, and assistance with activities of daily living (e.g., bathing or getting dressed) or instrumental activities of daily living (e.g., fixing meals and taking medicines); and are isolated or their caregiver is experiencing burden.
A co-payment is charged for some Home and Community Based Services, such as Adult Day Health Care. The co-payment is based on your eligibility status and means test criteria. Contact your VA social worker/case manager to complete the Application for Extended Care Benefits (VA Form 10-10EC).
Note that Home and Community Based Services may be used in combination with each other.
Eligibility for Nursing Homes and Other Residential Care
Following is a summary of eligibility for nursing homes and other residential care. Your eligibility for these services is based on clinical need and setting availability. For more information go to the Nursing Home and Residential Care section of this Guide or visit https://iris.custhelp.com/app/home. You can also talk with your VA social worker/case manager about your eligibility for each of these services.
There are different eligibility requirements for each of these settings. Some of these residential settings are provided and paid for by VA and some are not.
Adult Family Homes (Adult Foster Homes)
This residential care setting is not provided or paid for by VA. Your VA social worker or case manager, however, may be able to help you with eligibility guidelines.
Assisted Living
This residential care setting is not provided or paid for by VA. Your VA social worker or case manager, however, may be able to help you with eligibility guidelines.
Community Living Center (VA Nursing Home)
To be admitted into a Community Living Center, you must be enrolled in the VA health care system and have clinical need for nursing home care. You must also be medically and psychiatrically stable. VA will pay for Community Living Center care if you meet certain eligibility criteria involving your service connected status, level of disability, and income. If you do not meet these requirements, a co-payment may be charged for this care. Medicare usually does not pay for a Community Living Center.
Community Nursing Home
The VA will pay for Community Nursing Home care if you have clinical need for nursing home care and meet eligibility criteria involving your service connected status, level of disability and income. If you do not meet these requirements, you will have a co-payment for Community Nursing Home care. Medicare usually does not pay for Community Nursing Home care.
Medical Foster Home
In order to live in a Medical Foster Home you need to be enrolled in Home Based Primary Care. You will continue to receive Home Based Primary Care services in the Medical Foster Home. VA, however, will not pay for the cost of living in a Medical Foster Home. The charge for a Medical Foster Home is about $1500 to $3000 each month based on your income and the level of care you need.
State Veterans Home
Each State establishes eligibility and admission criteria for its homes. Some State Veterans Homes may admit non-Veteran spouses and gold star parents while others may admit only Veterans. A recognized State Veterans Home may receive payments from VA to help defray the cost of care provided to Veterans. The cost to you varies by state. VA does not pay for care of non-Veterans.
