Veterans Health Administration ServicesHilary Edgerly, LCSW

Assistant Chief, Social Work Service

VA Illiana Health Care System, Danville, IL

Department of Veterans Affairs

Three Administrations: Veterans Health Administration (VHA): Includes all hospitals,

clinics and Vet Centers

Veterans Benefits Administrations (VBA): Oversees all monetary benefits, including but not limited to disability, education benefits, and life insurance

Veterans Cemetery Administration (VCA): Operates all 131 National Cemeteries in the U.S. and Puerto Rico.

Service Connected v. Non Service Connected

Veterans with an injury or illness that they believe is related to their military service can file a disability claim.

Claims can be filed without assistance but it is recommended that Veteran’s Service Organizations(VSOs) Service Officers be utilized for assistance in filing claims.

Beware of individuals that charge a fee for filing claims!

VSOs are organizations such as AMVETS, DAV, and Illinois Department of Veterans Affairs.

Differences in general population and Veterans needing a Guardian

If Veterans were diagnosed with a serious mental illness while in the military or within a year of discharge, they can be rated disabled by the VA.

Veteran rated 100%SC receives $2,816/month, not including dependent pay or unemployability rating.

Often, Veterans with a serious mental illness have very large estates.

Basic Eligibility for General Services Persons who served in the active military who were

discharged under conditions other than dishonorable may qualify for VA heath care benefits.

Reservist and National Guard members may also qualify if they were called to active duty(other than for training only) by a Federal order and completed the full period for which they were called or ordered to active duty.

Those Veterans who enlisted after 9/7/1980 or entered active duty after 10/16/81 must have served 24 continuous months or the full period for which they were called to active duty. This requirement may not apply to Veterans discharged for

hardship, early out or a disability incurred or aggravated in the line of duty.

Enrollment

Veterans must apply for services. Complete VA Form 10-10EZ, Application for health Benefits.

Available at any VA facility or at www.va.gov/1010ez.htm

Four categories are not required to enroll. Veterans with a service-connected(SC) disability of 50% or

more.

Veterans seeking care for a disability the military determined was incurred or aggravated in the line of duty but has not yet been rated by VA (only within 12 months of discharge).

Veterans seeking care for a service-connected disability only (this does not happen very often).

Veterans seeking registry examinations (Ionizing Radiation, Agent Orange, Gulf War/Operation Iraqi Freedom(OIF) and Depleted Uranium).

Priority Groups

The number of veterans who can be enrolled in the health care program is determined by the amount of money Congress gives VA each year. Since funds are limited, VA set up priority groups to make sure that certain groups of veterans are able to be enrolled before others.

Priority Groups

During enrollment, each Veteran is assigned to a priority group.

Priority groups are used to balance demand for VA health enrollment with resources.

Currently, VA is able to serve Veterans in groups 1-7 with a subgroup in 8 that can also be served if they agree to pay copays.

Priority Groups

Group 1: Veterans with SC disabilities rated 50% or more and Veterans determined by VA to be unemployable due to SC conditions.

Group 2: Veterans with SC disabilities rated 30-40%

Group 3: Veterans with SC disabilities rated 10-20%; Veteran who are former POWs or awarded Purple Heart medal or the Medal of Honor; Veteran awarded special eligibility for disability incurred in treatment or participation in VA Vocational Rehabilitation program; and Veterans whose discharge was for a disability incurred or aggravated in the line of duty.

Group 4: Veterans receiving aid and attendance or pension benefits and/or Veterans determined by VA to be catastrophically disabled.

Priority Groups

Group 5: Veterans receiving VA pension benefits or eligible for Medicaid, and non-service connected (NSC) Veteran and non-compensable, zero % SC Veterans whose gross annual income and/or net worth are not greater than the VA financial thresholds.

Group 6: Veterans seeking care solely for certain conditions associated with exposure to ionizing radiation during certain periods; Project 112/SHAD participants; Veterans with compensable 0 % SC disabilities; Veterans who served in Republic of Vietnam between 1/9/62- 5/7/75 or SW Asia theater of operations from 8/2/90-11/11/98; and Veterans who served in a theater of combat operations after 11/11/98 as follows: Veterans discharged on or after 1/28/2003.

Priority Groups

Group 7: Veterans with incomes below the geographic means test income and who agree to co-pays.

Group 8: Veterans with gross household income above the VA national income threshold and geographically- adjusted income threshold who agree to pay co-pay. Group 8 is broken into sub-priorities that are somewhat

complicated. VA cannot serve some Veterans at this time with high income without another eligibility factor.

If they were enrolled as of 1/16/03 and continuously stayed enrolled, they will continue to be eligible for care with co-pays.

If they were enrolled on or after 6/15/09 but are within 10% of the income threshold, they are eligible with co-pays.

Eligibility for OEF/OIF/OND Combat Veterans: 5 years cost fee health care. OEF/OIF/OND combat Veterans can receive cost free

medical care for any condition related to your service in the Iraq/Afghanistan theater for 5 years after the date of your discharge or release

This includes 5 years (post-discharge) cost-free health care for any injury or illness associated with combat service

After the 5 year period ends, VA care and treatment will continue

At that point, Veteran could be responsible for co-pays that are based on your income and eligibility

But first the Veteran must enroll into VA health care!

OEF/OIF/OND Veterans

Other Injuries

Veterans who have non-combat related or non-service connected illnesses/injuries may be charged a co-pay for these conditions dependent on income level Determined officially by VA

For example, flu, colds, auto accident, etc.

A Time Sensitive Free Benefit

VA offers free dental benefits for evaluation and treatment for recently discharged Veterans

Veterans may qualify for these benefits if he/she meets both of the following requirements: served more than 90 days of continued service, and

DD214 does not show that they received all needed dental service at least 90 days prior to your separation

Note:  Veterans must apply for this dental care within 180 days (6 months) of separation from active duty service.

Co-payments

Veterans 50% SC and higher have no co-pays for any medical care received at the VA.

Veterans 10-40% SC have no copay for appointments but may be required to make medication copays dependent on their income.

VA can and will bill third party insurance for any visit that is not SC related.

Inpatient copays vary dependent on services provided and Veterans priority group.

Outpatient copays are as follows: Primary Care Services: $15

Specialty Care Services: $50

Medications: $8-$9 dependent upon income level of Veteran

Mental Health Services

Remember, not every Veteran who has sustained injuries in combat has PTSD. Trauma impacts all individuals differently. Grief and adjustment are normal reactions to injury.

VA offers a wide range of services for PTSD which include: Seeking Safety

Prolonged Exposure Therapy

Cognitive Processing Therapy (group or individual)

CBTI (for insomnia)

PAIRS (for couples)

Support Groups

Residential treatment programs available regionally

Mental Health Services Mental health counseling is available for a wide range of

diagnoses at both VAMC and community based outpatient clinics (CBOCs).

Acute Psychiatric inpatient services are available at most VAMCs, as well as Residential Rehabilitation Treatment Programs.

RRTP units can be general mental health rehabilitation. Some VA’s offer specialized units for certain diagnoses.

Services are provided by Licensed Individual Practitioners but primarily LCSWs, Psychologists, Psychiatrists, Physician Assistants and Nurse Practitioners.

VA has Evidence Based Therapy Coordinators at each VAMC. Goal is to have all staff who perform counseling to be trained (certified if possible) in some form of EBT.

VA is also working with community partners to expand the network of therapists available for Veterans with mental health treatment needs.

Local Recovery Coordinators have also been hired at each VA with the goal to have all treatment recovery focused rather than problem focused.

Other mental health services available…

Therapeutic Supportive Employment Services

Homeless Outreach and Case Management

Mental Health Intensive Case Management

Primary Care Mental Health Integration

Suicide Prevention Program

Residential Care Homes

Health behaviors/disease prevention programs

Pain Management

Substance Abuse Rehabilitation Program

Peer Support

Neuropsychology

Readjustment Counseling at Vet Centers

Therapeutic and Supported Employment Services

Includes Compensated Work Therapy (CWT) programs (Supported Employment, Transitional Work, Sheltered Workshops, and Veterans Construction Team), Incentive Therapy, and Vocational Assistance.

The TSES programs are based on a recovery-oriented model and offer a continuum of work restoration services.

Veterans are financially compensated for their work and in turn, improve their economic and social well-being as they prepare for community re-entry.

Health Care for Homeless Veterans (HCHV) HUD/VASH: Housing and Urban Development/VA Supported

Housing. HUD vouchers are distributed to Housing Authorities throughout the country for permanent housing for chronically homeless Veterans.

Outreach: Two Social Workers are traveling our area daily to link Veterans with Community Resources and reach out to Homeless Veterans who are not receiving care through the VA.

Substance Use Disorders: This program works with Veteran who are Homeless but also have substance use disorders, providing housing while supporting recovery.

Grant and Per Diem Program: Semi-permanent housing for Veterans. VA contracts with community partners and pays a daily per diem for each Veteran housed in their facility. There is a clinical component to all contract Grant and Per Diem Programs.

Peer Support

Peer Specialists and Peer Support Apprentices are a unique cadre of people joining VA’s mental health care teams.

They are Veterans who have successfully dealt with their own mental health recovery for a minimum of one year. Peer Specialists are trained and certified, while Peer Support Apprentices are undergoing training and certification to become Peer Specialists.

VA has hired over 800 Peer Specialists and Peer Support Apprentices since 2012.

Readjustment Counseling Services Vet Centers are located in all 50 states, the District of

Columbia, Guam, Puerto Rico, and America Samoa.

They are separate from the hospitals and clinics. Sometimes Veterans will be afraid to go to the VA but are more comfortable receiving services from a Vet Center.

Veterans are eligible if they served on active duty in a combat theater or area of hostility during World War II, the Korean War, the Vietnam War, the Gulf War, or the campaigns in Lebanon, Grenada, Panama, Somalia, Bosnia, Kosovo, Afghanistan, Iraq and the Global War on Terror. Veterans, who served in the active military during the Vietnam-era, but not in the Republic of Vietnam, must have requested services at a Vet Center before Jan. 1, 2004.

Vet Centers do not require enrollment in the VHA Health Care System.

Prosthetics Home respiratory therapy

Artificial limbs and recreation equipment.

Orthopedic braces and therapeutic shoes

Wheelchairs

Powered mobility (must be approved by team)

Crutches

Canes

Walkers

Special aids, appliances, optical and electronic devices for visual impairment

Other durable medical equipment and supplies

Veterans receiving VA care for any condition may receive VA prosthetic appliances, equipment and services. Veterans who are approved by VA for a guide or service dog may also receive service dog benefits including some veterinary care and equipment.

Hearing aides and eyeglasses have special eligibility.

Extended Care

Different eligibility criteria apply for Long Term Care (Nursing Home Care). Only Veterans who are 70% SC or greater, 60% SC and

unemployable, or require nursing home care due to a SC condition are eligible for LTC to be paid for by VA.

LTC can be provided in a contracted community nursing home with VA payment, in a VA Community Living Center (including Green Houses) or in a State Veterans Home.

In some special circumstances, those not meeting this criteria can be placed for short-term stay but could be billed up to $97 per day based on the Application for Extended Care Services (VA Form 10-10EC). Placement under another payment source must occur upon completion of goal of VA paid treatment or expiration of authorization for treatment.

Extended Care: Green HousesLiberty and Freedom THE GREEN HOUSE® Project offers a model for long-term

care designed to look and feel like a real home. Over the last decade Green House homes have set a new standard for quality care with a model that is both proven and practical.

VA Illiana Health Care System has two Green Houses. Each House offers 10 Veterans long-term care in a home-like setting.

The first homes were opened in 2012 and construction began on two additional homes this year. The two additional homes should open in Summer 2015.

The first homes require Veterans to meet LTC guidelines (70-100%SC or 60% and rated unemployable).

New homes will offer Dementia Care and Short Stay/Rehabilitation/Skilled Care.

Green House Project Video

http://thegreenhouseproject.org/videos#28

Extended Care: CLC

Community Living Centers offer skilled nursing services at the VA medical center.

70-100% SC or 60% SC and rated unemployable are eligible for indefinite stay.

Specialized care: Palliative Care Unit, Alzheimer’s and Related Disorders Unit, Geri-Psych Units, Rehabilitation

Interdisciplinary team consisting of Provider, RN, Social Worker, Psychologist, Pharmacist, Dietician, PT, OT, SLP, KT and RT.

Veterans not meeting LTC criteria can be admitted, pending bed availability for short-stay (less than 90 days). May be co-pay required. Social Workers assist with discharge planning to community via other payer sources.

Extended Care: CNH

Veterans who are LTC eligible can choose to receive their nursing home care in a Contract Nursing Home.

Each VA has Contracts with community nursing homes, allowing the Veteran to receive care closer to their home/family.

VA Social Workers and Nurses visit the Veterans in the CNH monthly for case management, coordination of care, and assessment of psychosocial needs.

CNH are paid a daily per diem rate. Follow-up care is arranged at the VA or in some pre-authorized cases with community hospitals and providers.

Special Authorization for CNH is approved for Veterans at End of Life or Veterans whose caregiver is in need of respite (30 days per year).

Extended Care: NIC

Non-Institutionalized Care: Veterans are eligible for NIC services based on need as determined by the interdisciplinary team.

Home Based Primary Care

Contract Adult Day Care

Homemaker/Home Health Aide Service

Bowel and Bladder Care

Home Skilled Nursing

Medical Foster Home

Respite Care

Extended Care: HBPC

Home Based Primary Care is VA’s version of visiting nurses.

An interdisciplinary team sees the Veteran in the Home. RN sees the Veteran every two weeks. Other disciplines (Social Work, Dietician, KT, Psychology, Provider) visit Veteran on a prn basis, but at least annually.

This program is a great resource for Veterans whose physical condition makes it difficult to travel to the VA Hospital or Clinic for appointments.

Extended Care: CRC

Community Residential Care is a partnership between VA and caregivers in the community who are willing to invite Veterans into their home.

CRC is a VA sponsored program that provides health care supervision to Veterans who do not require hospitalization or nursing home care.

These Veterans are not able to live independently because of their medical or psychiatric diagnoses. Their families cannot provide personal assistance or supervision.

Two types: Residential Care Homes and Medical Foster Homes

Extended Care: CRC

In both RCH and MFH, agreement is made between the VA and the caregiver/sponsor to become an approved home.

Each home is inspected and approved by the VA, but the Veteran pays for the care.

RCH is typically for Veterans requiring less physical care but may need prompting, cues, reminders, etc. Most Veteran’s in RCH have a psychiatric diagnosis.

MFH is more appropriate for Veteran’s with need for physical assistance. Homes only take 3 or less Veterans. All Veterans in MFH also receive HBPC services.

Caregiver Programs and Services

Caregivers are vital partners in the treatment of Veterans and Service Members.

Each VAMC has a Caregiver Support Coordinator to facilitate caregiver activities and serve as a resource expert.

Programs available for all Veteran Caregivers: In-home and community based care (skilled RN, H/HHA, CADHC, HBPC), respite care (in-home and nursing home), caregiver education and training programs, and family support services.

Caregiver Programs and Services:Caregivers and Veterans Omnibus Health Services Act of 2010

To be eligible, Veterans must have had a serious injury incurred or aggravated in the line of duty on or after 9/11/01.

Provides benefits to a parent, spouse, child, step-family member, extended family member or an individual who lives with the Veteran but is not a family member.

Benefits include: Monthly stipend based on the personal care needs of the

Veteran

Travel, lodging and per diem for training

Health Care Insurance through CHAMPVA

Mental Health Services

Comprehensive training

Respite care

Respite care during training

Appropriate caregiving instruction and training

Dental Insurance Dental Services have different eligibility requirements.

100% SC Veterans are the only Veterans eligible for VA dental benefits other than some special populations of Veterans such as homeless Veterans and Veterans rated by VA to have a service related dental injury.

VA’s Dental Insurance Program (VADIP) offers enrolled Veterans and beneficiaries of VA’s Civilian Health and Medical Program (CHAMPVA) the opportunity to purchase dental insurance at a reduced cost. VA is offering this service through Delta Dental and MetLife.

VADIP is a three-year, national pilot program to assess the feasibility and advisability of providing a premium-based dental insurance plan to eligible individuals. The program is mandated by Public Law 111-163, Caregivers and Veterans Omnibus Health Services Act of 2010.

Veterans enrolled in the VA health care program and CHAMPVA program beneficiaries are eligible to participate in VADIP. Participation in VADIP will not affect Veterans’ eligibility for VA dental services and treatment.

VA and ACA If a Veteran is enrolled in VA health care, the Veteran does

not need to take additional steps to meet the health care law coverage standards. The health care law does not change VA health benefits or Veterans’ out-of-pocket costs.

If a Veteran chooses to cancel his/her VA health care enrollment, he/she may reapply for enrollment at any time; however, acceptance for future VA health care enrollment will be based on eligibility factors at the time of application, which may result in a denial of enrollment.

If a Veteran is not enrolled in VA health care, he/she can apply at any time

Family members are a key part of Veterans good health and support network. VA health care coverage is available for family members of certain Veterans who are permanently and totally disabled or died serving our country and in some cases, Veterans with children who have Spina Bifida.

Veterans can have private insurance and VA health care benefits concurrently.

For more information:

Crisis Line: 1-800-273-TALK

VA Health Eligibility Center: 1-877-222-VETS (8387)

VBA Call Center: 1-800-827-1000

www.va.gov

www.va.gov/health/aca/

http://thegreenhouseproject.orrg

References

Public Law 111-163, Caregivers and Veterans Omnibus Health Services Act of 2010

www.va.gov

Any questions?