VA Pulls the Cord on UMEs in Senior or Independent Living Facilities

The Department of Veteran’s Affairs recently “pulled the cord” on counting room and board in Senior or Independent Living Facilities as unreimbursed medical expenses (UMEs) that may be deducted from income for pension purposes:

Current VA regulations require the deduction of UMEs from income for purposes of the pension program. In the past, UMEs for room and board at a senior or independent living facility (i.e. residence in a protected environment with emergency pull cords, 24-hour staffing, and locked exterior doors) were deductible.

Now, in order to claim room and board as an unreimbursed medical expense, a claimant must receieve assistance with two or more Activities of Daily Living, such as bathing, showering, and dressing, at the facility where he or she resides.

If the facility does not provide the claimant custodial care, or the claimant’s physician does not prescribe care by a third-party provider in that facility, the VA will not deduct room and board paid to the facility. It will, however, deduct the cost of any medical or nursing services obtained from a third-party provider.

For pension applicants not residing in nursing homes or assisted living facilities, we must now demonstrate the following in order to claim unreimbursed fees for room and board as a deductible medical expense:

  • the claimant is rated for pension at the Aid & Attendance or housebound rate
  • a physician has stated in writing that the claimant needs to be in a protected environment
  • the residential facility provides the individual assistance with two or more Activities of Daily Living
  • Or, a third-party contractor provides assistance to the claimant with two or more Activities of Daily Living at the residential facility and there is a statement of record from the claimant’s physician that the individual must reside in that facility in order to receive the contractor’s assistance with ADLs

Note that all claims rewarded and/or submitted prior to this change are ‘grandfathered’ in and will not be affected by the new interpretation of unreimbursed medical expenses. However, if a claimant currently receiving benefits relocates to a different facility that is not a nursing home or assisted living facility , the new criteria will apply.

This entry was posted in Asset Protection, Elder Law & LTC Planning, Estate Planning & Administration, Government Benefits, Long Term Care, Veterans Benefits. Bookmark the permalink.

Comments are closed.