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How to Get Approved for the VA Caregiver Program

How to Get Approved for the VA Caregiver Program

The VA Caregiver Program has been extended to veterans of all eras, as of late 2022! If you are a veteran (or care for a veteran) who needs in-home assistance from a loved one, then you need to know about this incredible program that could put more money in your pocket.

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I have extensive experience with the VA Caregiver Program and I have seen it change the lives of countless veterans over the years. However, I also know firsthand that it can be very difficult to get approval even when your case appears obvious.

For example, my homebound father was recently denied his initial claim for these benefits even though his medical record clearly demonstrated his need for care. It’s clear that he will get those benefits on appeal, but it’s been quite a process to get those benefits.

In this article, we’ll talk about what this program is, who is eligible for it, how to get approved for the VA Caregiver program and everything else that you need to know.

What is the VA Caregiver Program?

The VA Program for Comprehensive Assistance for Family Caregivers (PCAFC) is a program that provides supportive services and a monthly check to family members who assist disabled veterans. Many spouses and loved ones are already providing that care anyway, but this program makes it easier.

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The reason the VA offers this program is because it’s cheaper to pay a family member to take care of a veteran than it is to pay for that veteran to get help from a professional home health agency or nursing home. It’s also much more convenient and pleasant for the veteran because they are able to stay in their own homes with the people they love.

Who is eligible for the VA Caregiver Program?

There are several requirements for the PCAFC Caregiver Program and it can be difficult to understand all of the requirements. Both the veteran and the caregiver must meet specific requirements in order to receive benefits from this program.

Requirements for the Veteran

The first thing the VA Caregiver Program will do is establish whether or not the Veteran meets the eligibility requirements for this program.

The PFAFC is for Veterans and members of the Armed Forces who are pending medical discharges from the military. Although military members can apply before their med-board is technically complete, I will refer to the applicant as the Veteran throughout the remainder of this post.

The Veteran must have a serious injury (or illness) that was incurred or aggravated in the line of duty while the Veteran was on active duty. The program defines “serious” as a disability that is rated at 70% or more by the VA. That 70% rating can be from a single disability or a combined rating from multiple disabilities.

The Veteran must need in-person personal care services for at least six months. The PCAFC specifically lists three reasons why a Veteran may need this care, and the Veteran must meet one of the three requirements in order to participate in the program.

  1. The Veteran is unable to perform one or more Activities of Daily Living (ADLs).
  2. The Veteran needs supervision or protection because of the symptoms or residuals of an impairment or injury, OR
  3. The Veteran needs frequent or detailed instruction or supervision in order to function in daily life.

For the purposes of the VA Caregiver Program, the ADLs include:

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  • Dressing (or undressing)
  • Bathing
  • Grooming
  • Adjusting prosthetics or orthopedics
  • Toileting or attending to toileting
  • Feeding onesself
  • Mobility

If a Veteran qualifies based on the ADLs, the Veteran must be completely unable to perform that ADL on their own. If they only need help some of the time, that wouldn’t qualify. A veteran must always need assistance.

Alternatively, a Veteran may be eligible if they need ongoing supervision, protection or instruction. There are many reasons why a Veteran may need this assistance, including Traumatic Brain Injuries (TBI), dementia, and other injuries or illnesses.

Other reasons why a Veteran may need supervision include seizures, blackouts, safety risks, danger of falling, difficulty with sleep regulation, delusions, hallucinations, memory problems, and self-regulation (such as being able to moderate moods, agitation and aggression). Veterans who have difficulty planning and organizing (such as sticking to a medication plan) may also require supervision.

Requirements for the Caregiver

After the Veteran’s eligibility is established, the VA Caregiver Program will evaluate whether or not the Family Caregiver is eligible for this program.

A Family Caregiver must be at least 18 years old. Children are not allowed to serve as family caregivers in this program.

The Caregiver must be either an eligible family member or someone who lives with the eligible veteran full-time. Eligible family members include the Veteran’s spouse, son, daughter, parent, step-family member, or extended family member. If the caregiver is not a relative, the caregiver must live with the Veteran full-time and continue to live with them full-time after being accepted to this program.

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Of course, the caregiver must also be determined to be capable of caring for the Veteran. Family Caregivers are required to participate in caregiver education and training programs, and demonstrate their ability to take care of the veteran.

If it is determined that the Veteran has been neglected or abused, the Family Caregiver will not be eligible to participate in this program.

What are the VA Caregiver Program benefits?

The primary Family Caregiver will receive a generous monthly payment from the VA Caregiver Program. This amount of that payment is determined on the extent of the care required by the veteran.

Level One Veterans are those who need help one or two ADLs but do not require continuous supervision.

Level Two Veterans are those who are “unable to self-sustain in the community” without assistance. That means that the Veteran needs help with at least three of the seven ADLs or that the Veteran needs supervision, protection or instruction.

Both of the stipend levels are based on the stipend rate from the Office of Personnel Management General Schedule Annual Rate for grade 4, step 1. That sounds complicated, but really it just points to a certain square on the annual charts that are published on the OPM website.

For example, that rate is $33,693 in 2023 for most areas of the United States. If you live in San Francisco, the rate is $41,690. There are about 50 separate charts for different geographic areas, but I believe San Francisco is the highest.

The stipend will be paid as of the application date, even though it takes about 90 days to process the application. That means that your first payment should include backpay for the months when your application was pending.

Level One Stipend

Level One Veterans are those who need help with one or two ADLs. They do not require continuous supervision, instruction or protection.

Level One pay is calculated by finding your locality rate on the OPM website and then dividing that number by 12 and multiplying it by 0.625.

For example, in San Francisco, the rate is $41,690 in 2023. If you divide that by 12, you get $3,474.16. Multiply that by 0.625 and you get $2,171.35. That’s how much the monthly stipend would be for a Level One Family Caregiver in San Francisco.

In the majority of the United States, the rate is $33,693 in 2023. When you follow the same process of dividing by 12 and multiplying by 0.625, you find that the monthly payment is $1,754.84 in most areas of the United States.

Level Two Stipend

Veterans who need help with at least three ADLs or need supervision, protection or instruction may qualify for a Level Two stipend.

The Level Two stipend is based on the same OPM stipend table. However, the Level Two calculation just divides that rate by 12. You don’t need to multiply it by 0.625.

That means that the San Francisco rate is $3,474.16. Other major geographic areas, like Dallas Detroit, San Jose, Seattle, Washington DC, Alaska and Hawaii, have their own separate rates.

The Level Two stipend rate is $2,807.75 in the rest of the United States.

Other Benefits

In addition to a monthly stipend, Family Caregivers can also receive mental health counseling, health insurance (if they are uninsured), respite care, education and training, and other benefits.

The health insurance is provided through CHAMPVA and is actually quite comprehensive. I am insured by CHAMPVA and I have actually really liked having this coverage.

How do you apply for the VA Caregiver Program?

Applying for the VA Caregiver Program is easy! You can apply online, by mail or in person. You will need to fill out VA Form 1010CG if you want to apply by mail or in person.

When you fill out the application, you will need the following information:

  • Veteran’s basic identifying information
  • Veteran’s contact information
  • Veteran’s nearest VA medical center
  • Caregiver’s basic identifying information
  • Caregiver’s contact information
  • Caregiver’s current health insurance information

The application only takes about 15 minutes and it’s fairly straightforward. Every Veteran can assign one Primary Family Caregiver and two Secondary Family Caregivers.

Evaluation Process

After your application is received, you will be contacted by the Caregiver Support Coordinator at your local VA Medical Center. This is where the process starts to get quite complicated.

The Support Coordinator will schedule an intake appointment. This may be conducted in your home or over telehealth. These intake appointments can take two hours or longer, depending on the extent of the Veteran’s needs.

During this appointment, the medical assessor will determine the level of care that the veteran requires. This is used to determine if the Veteran qualifies for Level One or Level Two care. The stipend, or payment, is determined by the tier level that the veteran is assigned.

There are a lot of appointments that happen before a Veteran is approved for this program. It is not uncommon to meet with three or four different providers and each appointment could take up to two hours. There is a lot that goes into evaluating veterans for this program.

Training

The Family Caregiver will be required to complete mandatory training. This is usually offered online or through a DVD workbook curriculum. In some areas, an in-person training class may be available.

The training covers ten subjects, including self-care, nutrition and managing medications.

Home Visits

One of the hallmarks of the VA Caregiver Program is frequent home visits. These visits are conducted quarterly to ensure that the Veteran is safe at home.

The first home visit is done prior to final approval. This is conducted to ensure that the Family Caregiver is physically capable of providing the needed care and to verify that the home is safe for the Veteran.

This visit is conducted by a medical professional (such as a registered nurse or physician’s assistant) or in collaboration with a mental health provider, depending on the type of veteran’s need.

Final Approval

Final approval for this program is not granted until all the onboarding steps are complete. If denied, Veterans can request a clinical review, a higher-level review, or even appeal the decision to the VA Board of Veterans Appeals.

The instructions for an appeal are always included in the denial paperwork.

What happens after approval?

After approval, the stipend will begin to be paid via direct deposit near the 1st of every month. Other benefits, such as health care and respite care, will be explained in more detail by the local CSC.

The program requires quarterly home visits by clinical staff. These visits have several purposes, including:

  • Checking on the veteran’s well-being
  • Verifying that the caregiver still has the physical capacity to provide care
  • Checking the safety and adequacy of the home

After one year of satisfactory home visits, these visits can be conducted over the phone for veterans who do not face exceptional medical risks.

Other Benefits for Veterans

Veterans who qualify for the VA Caregiver Program will almost certainly qualify for Individual Unemployability, which is a program that increases a Veteran’s disability compensation to the 100% rate when they cannot maintain gainful employment.

You can’t exactly maintain gainful employment if you require a caregiver, so I’ve found that it’s usually very easy to get IU once you’re participating in the VA Caregiver Program.

In addition to this, you may also be eligible for free state parks passes, property tax exemptions, free vehicle registration and other benefits!

Ester Hill

Monday 18th of September 2023

I have applied for the Caregivers Program on behalf of my husband who is 100% disabled and was denied. I appealed and did not realize that I was appealing to the board and have not heard from them. I can see that my appeal is still pending, but I have no idea how long this will take. Is there a way to get this information? It has been over 24 months since my appeal.I appreciate whatever information you vacant give me. Mrs. Hill

Catherine Marucci

Friday 22nd of September 2023

Hi. I would suggest calling the VA Caregiver Support Line: https://www.caregiver.va.gov/help_landing.asp