As Congress and the President debate putting limits on Medicare and Medicaid, new restrictions are also being placed on Veterans benefits.

Recently, the VA has changed its policy in a way that limits
the pension awards available to veterans who are receiving care in senior and
independent living facilities. Issued as a “clarification” of policy, VA
Fast Letter 12-23
limits the unreimbursed medical expenses (UMEs) that may
be deducted from income for pension purposes – specifically in regard to the
cost of room and board at a facility. 

Fast Letter 12-23 discusses the circumstances under which
the cost of room and board paid to senior or independent living facilities will
be treated as a UME. It suggests that in some past cases the VA has been too
generous in allowing veterans to deduct such room and board costs. The Fast
Letter concludes that room and board is only a deductible UME when the facility
provides custodial care. 

Custodial care is care that assists persons with the
activities of daily living (ADL). As defined in VA regulations, ADLs involve
basic self-care and include bathing or showering, dressing, eating, getting in
or out of bed or a chair, and using the toilet. The Fast Letter notes that
“[t]o preserve the integrity of the pension program, VA considers a facility to
provide custodial care if it assists an individual with two or more ADLs.” [My
translation: “to preserve the integrity of pension program” means “to save

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