The Veterans Directed Home and Community Based Services program, sometimes referred to as “Cash and Counseling for Veterans” or as “Independence Plus”, is designed to allow veterans who are potential candidates for nursing home placement to receive a comparable level of care in their own homes. The program provides veterans with a budget and allows them to choose their own care providers in place of receiving care services from the VA health care system.  In some cases, family members of the veteran can be paid for the care they provide.

“Independence Plus” program allows veterans to prioritize their own care needs, select their own care providers, and act as an employer instead of receiving nursing home care from the VA directly.  This program started in 2009 and is being rolled out through local VA Medical Centers.  Currently, this program is administered out of Bedford, MA.

How does “Independence Plus” work?

1. The veteran, working with family, and usually an advisor from the state, develops a Care Plan outlining the services, supports, supplies and estimated budget for the veteran to live at home or in the community instead of a nursing home.  The “Care Plan” may also be called a “Participant Spending Plan”.
2. Veteran submits Care Plan for approval to the administering agency.  The Plan is reviewed, and any required modifications are agreed upon through a collaborative dialogue and communication process.  Upon consent and approval, a spending budget is established for the veteran.
3. The veteran now has the “independence” to make personalized choices.  He/she may hire and schedule all care providers and service providers.  The veteran can make buying decisions on relevant and necessary supplies.  Typically a veteran may hire relatives and friends to provide personal care services, with the exception of their spouses or legal guardians.  Hired care providers are expected to pay taxes for the wages received.
4. The administering agency provides a Financial Management Service that pays for care and issues checks to the service providers and/or reimbursement for goods purchased with pre-approval.  Payments made to care and service providers are authorized by both the veteran and the Financial Management Service.

“Independence Plus” programs are not appropriate for everyone.  There is a substantial effort required of the veteran, and/or their family, to determine care requirements, selection of care providers, and ongoing management oversight of the care services.  However, for many families the independence to choose care providers, the potential to pay family members for their assistance, and the ability for the veteran to continue living at home make participation in this program well worth the effort.

It is worth noting, 1) any veterans enrolled in the VA Health Care System are not eligible  to be considered for Medicaid assistance.  However, 2) war-time veterans can and do participate in the “Independence Plus” program and still be eligible for the Veterans Aid & Attendance pension benefit.

Veteran Status Requirements:
Most veterans are required to have had 24 months of continuous active duty military service.  However, there are exceptions to the 24 month rule.  For example, 1) Reservists or National Guard members that were called to Active Duty and completed their terms; 2) Those requiring treatment for a service-connected condition or disability; and 3) Those discharged or released from active duty for a hardship or an “early out.”

Veterans will need an “honorary” discharge status from their military branch.  In other words, vets with a discharge status defined as “bad conduct” or “dishonorable” will not be eligible to participate in this benefits program.

Veterans are eligible provided they require “nursing home level care”: “Independence Plus” is open to veterans of any age.  However, veterans must be enrolled in the VA Health Care system, and their health/medical needs require a nursing home level of care.  Obviously, there are multiple factors and individual exceptions associated with this requirement.  Typically, eligible veterans will require assistance with three (3) or more “activities of daily living”.  Restrictions are less rigid for those veterans over 75 years of age, or who are clinically depressed, or receiving hospice care, or currently live alone. A veteran’s marital or family status does not effect their eligibility for participation in this program.

“Independence Plus” programs will pay for a very wide range of services and goods.  Generally, any product or service that is required for the participant’s care, health maintenance, and/or improves the participant’s ability to live independently — will usually be covered by the program.  For example, a partial list of products and services that are typically covered includes:  adult day care, home care services, home safety services, shopping and errands, health counseling, and electronic emergency response systems.

There are no specific financial requirements to enable receipt of benefits.  “Independence Plus” does not have specific income and asset limits.  However, participants must be enrolled in VA Health Care, and be assigned to a “priority group” within the VA health system.  (Please note:  some “priority group” benefits are impacted by the veteran’s income and assets declaration.)

Also please be informed:  Aid and Attendance payments are not considered when determining the veteran’s care budget in the Veterans Directed Home and Community Based Services.

Benefit Amounts & Limits:
The monthly budget allocated for a veteran’s care depends on their individual requirements and is determined during the development of their Care Plan.  The maximum amount may actually vary from state to state.  Further, not all states even offer this program.  However, it is offered in most New England states, including Massachusetts, Maine, New Hampshire, Vermont, and Connecticut.

Typically the cost of this care cannot exceed the cost for the same care were it provided by the VA in a skilled nursing facility.  In real dollar terms, budget maximums rarely exceed $4,000./month.  Veterans do not incur any costs to participate in the program.

Unfortunately, the time period to prepare and receive approval for a Care Plan can be lengthy.  Participants should expect several months before actually beginning to receive care services at home.  The process can be accelerated if a participant begins the hiring process for care providers (after submitting their Care Plan) while waiting for its approval.  However, no payments can be made until the Care Plan has been approved.

“Independence Plus” can cover a range of goods and services, but there are limitations.  The following are not covered through “Independence Plus”

• Any service duplication.  That is, a service benefit which the veteran already receives from the Veteran Administration
• Monthly rent, mortgage payments, or room and board
• Personal items, living expenses, and services not related to one’s disability or independence
• Experimental treatments which have not been medically approved by the Veteran Administration

Participants in the “Independence Plus” program receive a monthly budget to use for their personal care and relevant supplies in place of receiving the same from the VA Health Care system.  To be clear, the veteran authorizes the agency to pay service providers on his or her behalf, but does not personally receive the cash payments.

“Independence Plus” is a program still in various stages of development in different states across the country.  As is often the case, participation requirements may change as the program matures.  Any veteran applicant should contact their local VA Medical Center to learn more specific details concerning their care requirements, and to determine final eligibility.