By Joan Lunden, Next Avenue Contributor

When my mom’s dementia no longer made it possible for her to live alone, I began searching for an assisted living community. After I started working with an adviser from A Place for Mom — the senior-living referral service where I’m now a spokeswoman — I learned that my mother was eligible to receive Veterans Administration (VA) benefits that would help offset the costs of her care.

My mother had remarried a man who was a World War II veteran (my dad died in a tragic plane crash when I was 13). I had no idea that as the widow of a veteran there was this kind of financial assistance.

The Veterans Aid & Attendance Pensions Benefit

By the time I learned about the Veterans Aid & Attendance Pensions Benefit, my mom had already spent years in assisted living. She and I had no idea that the federal government guarantees veterans and their spouses some long-term care assistance.

When I finally found out about this program, I got to work immediately. I pulled together the necessary paperwork and sent in her application. But as life would have it, by the time my mom was accepted by the program, it was too late. She passed away just before her 95th birthday.

A Well-Earned Long-Term Care Benefit

In going through this process, I learned that, shockingly, only 5 percent of these assistance funds are even applied for, because people simply do not know about the program. And for that reason, as Veterans Day approaches, I want to spread the word to those Americans who could really use this well-earned long-term care benefit.

The Veterans Aid & Attendance Pension Benefit, or “A&A benefit,” provides up to $1,794 per month to a veteran, $1,153 to a surviving spouse or $2,127 to a couple. The money, which is tax-free, can be used for in-home care, board and care, an assisted living community or a private-pay nursing home.

This is helpful for many vets and their families because neither Medicare nor Medicaid pays for assisted living care. It’s kind of like a private nursing home insurance policy you haven’t had to pay into.

But like private insurance, there are certain qualifications you’ll have to meet before you can apply. (One of the best resources explaining the A&A benefit is VeteranAid.org, which provides a brief questionnaire to help you determine if you or your loved one can benefit from this program

How to Qualify

To qualify for the benefit, a veteran or spouse must meet requirements including:

Wartime service The veteran had to have served at least 90 days of active duty with at least one day during one of the specified wars. He or she must have had an honorary discharge.

Financial need This means assets of under $80,000 (excluding a home and a car). The VA takes into consideration “countable income” as part of assets, the veteran’s or spouse’s monthly income — including Social Security, pensions and IRAs — minus the costs of assisted living or in-home care.

Medical needs The veteran or spouse must need assistance with eating, bathing or dressing.

Experts say it takes six to eight months, on average to get approved; some applicants wait more than a year. But once the application is approved, it’s applied retroactively to the date of application.

On Veterans Day, it is my hope that all wartime veterans and their spouses can find a senior community where they can feel safe and happy in their later years and can get the financial assistance that they deserve from the Veterans Aid & Attendance Pensions Benefit program. And I would like to thank all veterans and their families for their service to our country.

By Lynnley Browning and Laura Davison

Vice President Mike Pence said Republicans would repeal the estate tax — a step that the Senate GOP tax plan doesn’t currently plan to take.

“Death should no longer be a taxable event,” Pence said Thursday night during the annual dinner of the Tax Foundation, a conservative-leaning Washington policy group. He promised that the tax-overhaul plans now under consideration in Congress would eliminate the levy — a long-sought Republican goal.

Pence also promised his audience that Congress would repeal the Affordable Care Act’s requirement that individuals buy health insurance — a provision that Senate tax writers have added to their plan but the House hasn’t included.

“We will repeal the death tax once and for all and cut taxes on working Americans when we repeal the Obamacare individual mandate in this bill,” Pence said.

He also called for creating a new 25 percent tax rate on partnerships, limited liability companies and other so-called “pass-through” businesses. That’s in the House bill, but not the Senate plan, which would use a different approach.

The vice president’s mix-and-match promises contradicted White House Press Secretary Sarah Huckabee Sanders’s earlier response to a question about differences in the two chambers’ plans. Sanders told reporters Thursday afternoon that President Donald Trump likes both the Senate and the House plan, and doesn’t prefer one over the other.

The two chambers will have to compromise on a final bill before it could reach Trump’s desk.

The House on Thursday passed an ambitious tax overhaul that would include a provision to repeal the estate tax in 2025. But the Senate plan, which remained under discussion by the Senate Finance Committee Thursday night, would leave the tax in place.
Tax Thresholds

Under current law, the estate tax applies a 40 percent levy to estates worth more than $5.49 million for single individuals and $10.98 million for couples. The bill approved by the House would double the exemption thresholds for the tax, and then repeal it. The Senate measure would also double thresholds, but that change would be temporary, and end in 2026.

The Senate Finance panel is also considering the repeal of the individual mandate that was part of the 2010 health care law known as Obamacare. Abolishing the mandate beginning in 2019 would save the federal government $318 billion over 10 years that would help pay for the deep tax rate cuts that Republicans want to enact. But it would also leave 13 million Americans uninsured by 2027, according to an estimate by the Congressional Budget Office.

The chambers are also divided on how to cut taxes for closely held businesses that are organized as pass-throughs. Such businesses don’t pay tax themselves, but pass their earnings to their owners, who then pay tax at their individual tax rates.

The House legislation would tax some such businesses at 25 percent — and provide additional breaks for smaller businesses. The Senate plan would take a different approach, granting pass-through owners a 17.4 percent deduction — up to a certain threshold — before taxing the income at their individual rates.
Different Plans

Senate leaders have said they plan to hold a floor vote on their bill during the week of Nov. 27. But several Senators have already expressed concerns about aspects of the proposal –including pass-through tax treatment, the inclusion of the individual mandate repeal, and the impact the entire plan could have on federal budget deficits.

Pence said the ultimate tax bill would be the “biggest tax cut in American history” and pass before the end of the year. But recent studies suggest that the tax plans — both of which would reduce federal revenue by $1.4 trillion or so before accounting for any larger economic effects — would be shallower than than those enacted in 1981 under then-President Ronald Reagan.

The Centers for Medicare and Medicaid Services (CMS) has announced that the 2018 premium for Part B of Medicare will remain at $134 a month. But even with no change, millions of Social Security recipients will pay sharply higher Part B premiums that will eat up all or most of next year’s 2 percent cost of living adjustment (COLA) for Social Security.

To explain why, let’s back up and explain some basic facts of Medicare. Part B covers insured expenses for doctors, outpatient services and durable medical equipment. (The other component of basic Medicare is Part A, which covers hospital and nursing home expenses.)

Increases in Medicare premiums can’t cause a person’s Social Security benefits to decline from one year to the next, according to Social Security’s “hold harmless” rule. About 30 percent of Medicare beneficiaries are not held harmless each year. This group includes people who have not yet begun receiving Social Security benefits, new enrollees in 2018, low-income people whose Medicare premiums are paid by state Medicaid agencies, and people who pay Medicare’s high-income premium surcharges.

Recent COLAs have been very small – zero in 2016 and 0.3 percent this year – so increases in Part B premiums were either eliminated or reduced for most of the 70 percent of Medicare enrollees who have Part B premiums automatically deducted from their monthly Social Security payments.

Those hold-harmless reductions will disappear next year for most people, with some or all of their 2 percent COLA increases eaten up by increases in their Part B premiums. The numbers here can be confusing, so please bear with me.

According to CMS, 60 percent of those who will be held harmless in 2018 (equal to 42 percent of all Part B enrollees) will pay the full Part B premium. In other words, the 2 percent COLA will generate enough increased benefits for them to pay $134 without reducing their net Social Security benefits.

For the other 40 percent of those held harmless (28 percent of all Part B enrollees), their Social Security COLA increase will not be sufficient to cover the entire Part B premium. They will pay a range of smaller Part B premiums, based on their 2018 COLAs.

To figure out how this will affect you, subtract your current Part B premium from $134. Then multiply your current monthly Social Security benefit by 2 percent. Your 2018 Part B premium change should be the smaller of these two numbers. Add this figure to your 2017 premium to determine what you will pay next year. Like I said, it’s confusing.

One thing is clear: Many Social Security recipients will receive little if any boost in their benefits next year. And while most of these folks have been shielded by the hold-harmless rule from paying the full Part B premiums in recent years, I don’t expect any of them to send thanks for this to the folks at Social Security and Medicare who came up with this system for determining Medicare premiums.

Here are other important 2018 benchmark numbers announced by CMS:

The Part B annual deductible will be unchanged at $183.

The Part A annual deductible will rise by $24 to $1,340 from $1,316. There is a separate deductible for each hospital stay, usually defined as being separated by at least 60 days during a calendar year.

The Part A coinsurance charge for hospitalizations lasting from 61 to 90 days will rise by $6 to $335 a day in a benefit period; for lifetime reserve days linked to longer stays, it will rise $12 to $670 a day. The coinsurance charge for skilled nursing facility stays lasting from 21 to 100 days in a benefit period will increase by $3 to $167.50.

People who have worked at least 40 quarters in jobs where they paid Social Security payroll taxes qualify for premium-free Part A. The Part A premiums for people with 30 to 40 hours of coverage will rise by $5 to $232 a month. For those with fewer than 30 hours, it will increase $9 to $422 a month.

There will be no changes next year in Medicare’s high-income Part B premium surcharges, while the Part D surcharges will decline slightly. Details on both sets of surcharges may be found here.

By — Philip Moeller

A U.S. district court holds that a Medicaid applicant’s § 1983 case against the state for imposing a penalty on the transfer of her home to her caregiver son is barred by the Eleventh Amendment because she seeks retroactive relief from the transfer penalty. Williams v. Connolly (U.S. Dist. Ct., D.N.J., No. 17-1631 (RBK/AMD), Nov. 15, 2017).

John Davis brought his mother, Elizabeth Williams, to live with him in 2012 when she was diagnosed with Alzheimer’s disease. Mr. Davis sold his mother his home and cared for her in the home for three years. In 2014, Ms. Williams deeded the home back to Mr. Davis for $1 and entered a nursing home. In 2015, Ms. Williams applied for Medicaid benefits. The state imposed a penalty period because Ms. Williams had transferred the home to Mr. Davis.

Ms. Williams appealed, arguing that the caregiver exemption applied to the transfer. The state determined that the transfer did not fall within the caregiver exemption because Ms. Williams paid for additional caregivers in addition to her son. Ms. Williams sued the state in federal court under § 1983. The state filed a motion to dismiss.

The United States District Court, District of New Jersey, grants the state’s motion to dismiss, holding that because the claim seeks retroactive relief from the transfer penalty, it is barred by Eleventh Amendment immunity. According to the court, it “cannot require the State of New Jersey to pay benefits it previously determined it would not pay.”

By Bill Chappell on NPR.org

After thousands of U.S. veterans won a class action suit against the military over being used in chemical and biological testing, the Army says it will pay for their medical care. But the group’s attorneys say the service is falling short of meeting its obligations and that it’s withholding details veterans are seeking about what agents they were exposed to.

The Army says veterans can be treated for any injuries or diseases caused after the service used the soldiers as research subjects in the period from 1942 to 1975.

Notification letters went out to known class members on Nov. 1, the service says.

As for the size of the response, MEDCOM Public Affairs Chief Maria L. Tolleson said via email, “Two applications are in process and we have had about 40 more people call in who intend to apply.”

As for how to apply for treatment or coverage through the program, the Army says its Medical Command is conducting “an exhaustive search” for veterans who may have been research subjects “so that no individual who may benefit from medical care is inadvertently omitted.”

The lawsuit dates to 2009. It was filed by the Vietnam Veterans of America and other plaintiffs who wanted to know which chemical agents they had been exposed to — and whether those agents might have caused health problems. A court decided in the plaintiffs’ favor in early 2016.

While the Army has sent letters to at least some of the plaintiffs, it hasn’t issued broad notifications, as required by court documents.

The Army says it sent notification letters to known class-action members on Nov. 1.

As for the size of the response, “Two applications are in process and we have had about 40 more people call in who intend to apply,” MEDCOM Public Affairs Chief Maria Tolleson said via email.

Tolleson said the Army is using traditional media and mailings to reach veterans who might be eligible, saying, We understand that our target group ranges in ages from mid-60s to late-80s and are likely not very active on social media.”

But while those communications inform veterans that they’re eligible for medical care, they’re not answering veterans’ questions about which specific agents they were exposed to.

The service tested more than 100 “biological and chemical warfare/threat agents and substances that mimicked these agents (simulants), as well as medications, vaccines, and other chemical and biological agent countermeasures,” according to Tolleson.

“The Army still has not provided notice to test subject veterans regarding the specific chemical and biological tests to which they were subjected — and their possible health effects,” says attorney Ben Patterson of the law firm Morrison and Foerster, which represents veterans in the case. Patterson says a court ordered the Army to disclose detailed information to the former soldiers four years ago, in an injunction from November 2013.

Patterson said the Army is imposing unnecessary hurdles in the process, “in an apparent attempt to discourage and prevent veterans from applying to the program and receiving the medical care to which they are entitled under the Army’s own regulation.”

As part of the class action lawsuit’s resolution, the Army is required to use a variety of means to contact former test subjects, from notification letters and a “publicly accessible website” to public notifications and social media accounts. The service has posted its plan to uphold its obligation on the Army Medicine military website. But there’s no mention of the plan on several social media accounts, including the official Army Medicine Twitter feed.

“The law firm representing the veterans estimates at least 70,000 troops were used in the testing, including World War II veterans exposed to mustard gas,” NPR reported in 2015, in a follow-up to our reporting on WWII vets.

As for who’s eligible for coverage, the Army lists these requirements:

A DD Form 214 or War Department (WD) discharge/separation form(s) or functional equivalent.
Served as a research subject in a U.S. Army chemical or biological substance testing program, including the receipt of medications or vaccines under the U.S. Army investigational drug review.
Have a diagnosed medical condition that you believe to be a direct result of your participation in U.S. Army chemical or biological substance testing.

One veteran, Frank Rochelle, was injected in 1968 with a drug that made him hallucinate for nearly two days. He knows its identity only by its code name — CAR 302668.

“We were assured that everything that went on inside the clinic, we were going to be under 100 percent observation; they were going to do nothing to harm us,” Rochelle told NPR in 2015. “And also we were sure that we would be taken care of afterwards if anything happened. Instead we were left to hang out to dry.”

Last month, Rochelle received a letter from the Army — but instead of a detailed account of his medical history, it was a form letter, telling him that if he had volunteered to receive “medications or vaccines,” he might be eligible for medical care.

The military said it ended chemical and biological testing in 1975 after its chief of medical research admitted in a congressional hearing that his office didn’t have any way to monitor research subjects’ health after the tests were conducted.

In its FAQ about the treatment program, the Army also addressed the medical concerns of veterans who have served in more recent decades.

To the following question:

“I believe I have a disease or medical condition as a result of Army chemical or biological substance testing at FT McClellan (or other Army installations) during the 1980s (or 1990s), can I apply for medical care benefits under this medical care injunction?”

The military replies:

“No. This program is only available to former members of the Armed Forces who have an injury or disease resulting from their participation in a U.S. Army chemical or biological substance testing program.”

NPR Librarian Barbara Van Woerkom contributed to this report.