State veterans homes are a joint venture between state veterans departments and the Department of Veterans Affairs. Subsidies come from the state, VA and other sources. Most state homes are nursing homes for veterans but some homes may also provide assisted living and other care. States also provide a litany of other benefits for their veterans to include special recognition, free licenses and tax reduction.
About State Veterans Homes
Every state now has at least one veterans home. Some states have eight or more veterans homes. There are still a number of states that only have one home. There is great demand for this type of housing and it appears from news releases and Internet articles that a number of states are in the process of considering for construction or actually building more Veterans homes.
Veterans homes are generally available to former active duty veterans but some states have beds for people who served with the reserves or National Guard and for the spouses of veterans. The majority of these homes offer nursing care but some may offer assisted living or domiciliary care. Generally there is no income or asset test. Most veterans in most states would qualify. Many states have waiting lists of weeks to months for available beds. Each facility has different eligibility rules and there is an application process.
You cannot simply walk in the door and arrange for nursing care on the spot. You must contact the veterans home you are interested in to find out the availability of beds and the application process. For veterans who are on Disability Compensation or are currently in the VA healthcare system, there are significant subsidies available from the Department of Veterans Affairs. For veterans who are not on claim, there may be co-pays for the services of a State Veterans Home depending on the income of the veteran or the spouse who might also be eligible for a bed.
Available to Most Veterans but Not Always Free of Cost
State veterans homes fill an important need for veterans with low income and veterans who desire to spend their last years with "comrades" from former active-duty. The predominant service offered is nursing home care. VA nursing homes must be licensed for their particular state and conform with skilled or intermediate nursing services offered in private sector nursing homes in that state. State Homes may also offer assisted living or domiciliary care which is a form of supported independent living.
Every state has at least one veterans home and some states like Florida and Texas have eight of them. There is great demand for the services of these homes, but lack of federal and state funding has created a backlog of projects waiting construction over the years.
Unlike private sector nursing homes where the family can walk in the front door and possibly that same day make arrangements for a bed for their loved one; State Veterans homes have an application process that could take a number of weeks or months. Many State Homes have waiting lists especially for their Alzheimer's long term care units.
No facilities are entirely free to any veteran with an income unless the veteran is also receiving Disability Compensation at a certain disability rating. The veteran must pay his or her share of the cost. In some states the veterans contribution rates are set and if there's not enough income the family may have to make up the difference. Federal legislation, effective 2007, also allows the federal government to substantially subsidize the cost of veterans with service-connected disabilities in State Veterans homes. For veterans who are 70% or more disabled, the per diem contribution from the federal government, in most areas, is more than enough to cover the nursing home cost and for these veterans, there is no out-of-pocket cost.
The Appeal of Living in a State Veterans Home
We believe most veterans or their families seek out residency in a state veterans nursing home because they believe this service is one more VA entitlement that should be available to them.
But there is also a similar entitlement available to anyone in most private sector nursing homes -- facilities that may be geographically closer to the family than the nearest veterans home. This is Medicaid. Veterans seeking long term care from VA programs generally don't have the funds for private pay in a nursing home; however, Medicaid will also cover these same people in a private sector Medicaid certified facility. Most families who are seeking help for their loved ones, who are veterans, generally look to VA first before considering Medicaid. Or they are simply not aware of Medicaid. In many cases, Medicaid may be the better choice.
Aside from seeking long term care because of an expectation of entitlement are there any other reasons that veterans would prefer a State home? We asked this question of ourselves because we have noticed that in some states veterans homes are in distant rural areas. The fact that some of these homes are hundreds of miles from urban areas where the most veterans would tend to live, made us wonder why some veterans would move long distances to reside in these facilities.
To answer this question we contacted a number of rural State Veterans Homes on the phone and asked them why a veteran or his or her family would seek out their services as opposed to seeking services in a closer non-veterans facility under Medicaid. Almost unanimously the answer we got was that some veterans like the idea of sharing their living arrangement with other veterans. The facilities almost always referred to this as "camaraderie" – a band of brotherhood.
Statistically, private sector nursing homes are mostly populated by older women who are generally in poor health. Some men may not feel comfortable in an environment where the activities and the social atmosphere are centered around women. In contrast, veterans homes are almost exclusively populated by men. In addition, based on our observation, we suspect the population of State Homes is younger and healthier than that of private sector facilities.
These demographics would suggest that activities and the social atmosphere revolve around the needs of men not women. A younger, healthier population would also suggest veterans homes would offer more opportunity in the form of transportation or scheduled outings for the residents to be out in the community. One veterans home reported to us that they regularly scheduled fishing trips and outings to sporting events for their residents. These would be unheard-of activities for the typical private nursing home.
The second most common reason reported to us why veterans seek out State Homes is for financial reasons. In many states the cost of the home is subsidized for veterans who meet an income test. The vet's income is considered sufficient to cover the cost. These veterans may own a home or other assets that they wish to protect from Medicaid and leave to their family. Many State Veterans Homes will allow them to give these assets to the family without penalty. Medicaid would require a spend down of those assets or impose a penalty for gifting.
Another reason related to finances may be there are no available Medicaid beds in the veteran's area. The veteran may be paying out of pocket for a nursing facility but have his name on a waiting list for a State Home where the out-of-pocket cost would be much less. When his name comes up he will move to the State home.
A financial incentive for the veteran is that all State Veterans homes will apply for the Pension benefit for those residents who are eligible. Federal law prohibits VA from paying any more than $90 a month to single veterans who are eligible for Medicaid in a non-veteran nursing home. State Veterans homes are exempt from this rule and the single veteran can keep the entire Pension amount although most of it will have to apply to the cost of care. For those State Veterans Homes that also accept Medicaid, Pension represents additional disposable income.
History of State Veterans Homes
Our nation was faced with a staggering number of soldiers and sailors in critical need of medical care following the Civil War, and although national care provider homes were in operation at the time, their capacity was inadequate to meet the demand. At that time, several states established veterans homes, at their own expense, to provide for those residents who had served so honorably in the military.
In 1888, the U.S. Congress authorized federal cost-sharing for State Veterans Homes --about 30 cents per resident per day. Since the creation of the Veterans Administration in 1930, the program's per diem payments have increased every year with inflation.
Challenges Facing the Construction of New Homes
The State Veterans Home Program is a partnership between the U.S. Department of Veterans Affairs and the States to construct or acquire nursing home, domiciliary or adult day health care facilities. A State nursing home, domiciliary or adult day care is owned and operated by the State.
Under the State Home Construction Grant program, States are required to provide at least 35 percent of the total cost and federal grants can provide no more than 65 percent of the total cost.
Only projects that already have State matching funds qualify as Priority List Group 1 projects.
- For FY 2014, the federal share for proposed State Home Construction Grants was $928 million, of which $489 million were Priority Group List 1 projects. NASVH had recommended $250 million to cover half of the Priority 1 projects, but only $85 million was appropriated by Congress.
- For FY 2015, total estimated share of State Home Construction Grant requests rose to $976 million, of which $409 are Priority Group 1. For FY 2015, Congress appropriated $90 million, a small increase over VA's request, but not enough to seriously address the backlog of requests.
- For FY 2016, NASVH requests $200 million for the State Home Construction Grant program, to cover approximately half of the expected Priority Group 1 list. Unfortunately, VA's new FY 2016 budget submission actually decreased the request to just $80 million.
For Fiscal Year 2015 Project Funding VA received $90 million for the Fiscal Year 2015 program funding plus Fiscal Year 2014 carryover amounts by completing the final award of all fiscal year 2014 conditional grants.
For Fiscal Year 2015 VA will provide 18 new state home grants of $107 million which includes carryover funds. These funds are used for new facilities and repair and replacement on existing facilities for
- Little Rock Arkansas,
- Minneapolis Minnesota,
- Walla Walla Washington,
- Kearney Nebraska,
- Truth or Consequences New Mexico
VA received 36 initial grant applications for Fiscal Year 2016 for a total cost with matching funds from states of $385 million. This includes new construction and bed replacements for projects in TX, LA, NC, KY and SC.
Daily Per Diem Rates
Basic Per Diem Program
The Veterans Administration pays the State Veterans homes an annually adjusted rate per day for each veteran in the home. This is called the per diem and applies to veterans who are paying the out-of-pocket deductible and who don't qualify for the special per diem rate by being on claim for Disability Compensation.
The State Home basic per diem rates are listed in the table below by fiscal year (FY).
Adult Day Health Care
$89.52 per day
$48.50 per day
$112.36 per resident per day
$87.42 per day
$47.36 per day
$109.73 per resident per day
$85.37 per day
$46.25 per day
$107.16 per resident per day
$84.52 per day
$45.79 per day
$106.10 per resident per day
$82.54 per day
$44.72 per day
$103.61 per resident per day
$81.56 per day
$44.19 per day
$102.38 per resident per day
$79.96 per day
$43.32 per day
$100.37 per resident per day
$77.33 per day
$41.90 per day
$97.07 per veteran per day
The per diem program and construction subsidies mean that State Veterans Homes can charge less money for their services than private facilities. Some states have a set rate, as an example $1,600 a month, and they may be relying on the Pension benefit with aid and attendance plus the per diem to cover their actual costs. These states also may be relying on other in-state subsidies other than VA to help cover the costs. Other states may charge a percentage of the veterans income but be relying on other subsidies to cover the balance. Still, in other states, the rate may simply be the difference between all of the subsidies and the actual monthly cost of operation.
Most of the states with income-determined rates are selective about the veterans they accept. These states may rely on a variety of private and public sources to help fund the cost of care.
Example of Subsidy from the VA and the State
Actual per Veteran Monthly Cost of Operation
Per Diem Monthly to Subsidize the Veteran's Cost
Possible State or Other Subsidies
Possible VA Aid and Attendance Benefit
Available to Pay for Care from All Sources above
Veterans Out-of-Pocket Cost
States without set rate subsidies may charge 50% to 70% of the rate of private facilities based on private or semi-private room occupancy and if the veteran does not have enough income, these homes accept Medicaid or Medicare to make up the difference. In these states the Veterans homes are Medicaid and possibly Medicare certified. Approximately 30% of all State Veterans homes are CMS certified.
Prevailing Rate Per Diem Program
VA processes two different nursing home per diem rates:
- The prevailing rate (higher rate)
- The basic rate which we have discussed above
There are three ways a Veteran may qualify for the prevailing or higher rate:
- The Veteran has a service-connected disability of 70% or greater and is in need of nursing home care
- The Veteran has a rating of total disability based on individual unemployability (TDIU or IU). Veterans rated for P&T are not eligible for higher per diem. To validate eligibility of TDIU or IU, verify with your local Regional Office.
- The Veteran is seeking care for a specific, rated service-connected disability that is less than 70% (0-60%)
Payment for care under this second option constitutes payment in full for all routine nursing home care provided to the veteran in the state nursing home. As a condition for receiving this per diem, the veteran must receive medications through the state nursing home rather than from VA. The veteran must also utilize the VA for any services not provided by the nursing home, such as hospital care, hearing aids, and eyeglasses. If the veteran chooses to utilize other service providers, the veteran will be responsible for payment for those services.
In addition to the per diem payments discussed above, VA will also furnish drugs and medicines to a facility recognized as a State Veterans Home that are ordered by a duly licensed physician as specific therapy in the treatment of illness of injury for a veteran receiving care in a state home if the veteran:
- has a singular or combined rating of less than 50 percent based on one or more service-connected disabilities and is in need of such drugs and medicines for a service-connected disability and is in need of nursing home care for reasons that do not include care for a VA adjudicated service-connected disability; or
- has a singular or combined rating of 50 or 60 percent based on one or more service-connected disabilities and is in need of such drugs and medicines and is in need of nursing home care for reasons that do not include care for a VA adjudicated service-connected disability.
The drug or medicine must be included in VA's national formulary unless VA determines a non-formulary drug or medicine is medically necessary.
Type of Care Provided
Some state facilities offer assisted living or domiciliary care in addition to nursing care. Some states even build facilities devoted entirely for domiciliary. According to the Veterans Administration the definition of domiciliary care is as follows: "To provide the least intensive level of VA inpatient care for ambulatory veterans disabled by age or illness who are not in need of more acute hospitalization and who do not need the skilled nursing services provided in nursing homes. To rehabilitate the veteran in anticipation of his/her return to the community in a self-sustaining and independent or semi-independent living situation, or to assist the veteran to reach his/her optimal level of functioning in a protective environment."
A domiciliary is a living arrangement similar to assisted living without substantial assistance but is not intended as a permanent residence. Domiciliary rooms in veterans medical centers are designed around this concept and are used for rehabilitation recovery from surgery or accident, alcohol abuse, drug abuse, mental illness or depression.
The domiciliary concept does not work well in a State Veterans Home setting and in that context domiciliary is simply another name for assisted living without the assistance. This represents a form of independent retirement living with a little more support where the veteran can stay as long as he or she needs to. As far as State Veterans homes go you should think of domiciliary as a substitute for supported independent retirement living.
Many state veterans facilities have set aside a wing for Alzheimer's patients. In some states this is the most popular service sought by veterans or their families and waiting lists could require a number of years before a bed opens up. A small number of facilities offer adult day care.
It appears that in most of the states, facilities are run by state employees through their State departments. Some states may contract with third-party administrators to run their programs.
Eligibility and Application Requirements for State Veterans Homes
From state to state, facilities vary in their rules for eligible veterans. And even in the same state it is common, where there is more than one state home, for some homes to have very stringent eligibility rules and others to be more lenient. These differing rules are probably based on the demand for care and the available beds in that particular geographic area.
Some homes require the veteran to be totally disabled and unable to earn an income. Some evaluate on the basis of medical need or age. Some evaluate entirely on income – meaning applicants above a certain level will not be accepted. Some accept only former active-duty veterans, while others accept all who were in the military whether active duty or reserve. Still others accept only veterans who served during a period of war. Some homes accept the spouses or surviving spouses of veterans and some will accept the parents of veterans but restrict that to the parents of veterans who died while in service (Goldstar parents).
Federal regulations allow that 25% of the bed occupants at any one time may be veteran-related family members, i.e., spouses, surviving spouses, and/or gold star parents who are not entitled to payment of VA aid. When a State Home accepts grant assistance for a construction project, 75% of the bed occupants at the facility must be veterans.
Domicile residency requirements vary from state to state. The most stringent seems to be a three-year prior residency in the state whereas other homes may only require 90 days of residency. All states require an application process to get into a home. Typically a committee or board will approve or disapprove each application. Many states have waiting lists for beds.
State Veterans Home admission is only for eligible Veterans and certain categories of Veteran-related family members. The homes are not open to the general public. The categories of family members (non-Veteran residents) are:
- The spouses of Veterans; or
- The surviving spouses of Veterans; or
- Gold Star Parents
- The parents of children who have died while serving in the U.S. Armed Forces
The State Veterans homes Per Diem Program provides per diem payments to State Veterans Homes for the care of eligible Veterans only. Per diem is provided for the care of Veterans irrespective of whether the Veteran has wartime or peacetime service. VA does not have authority to control the management or operation of State Homes, including their admission practices. VA per diem may be paid for a Veteran who is eligible for care in a VA facility, but it is very important to know that not all veterans, on whose behalf VA pays per diem, are eligible for enrollment in VHA health care.
Application for the per diem program is made through using VA Form 10-10SH and VA Form 10-10EZ within 10 calendar days of admission.
Other State Veterans Benefits
Burial in State Veterans Cemeteries
At least 43 states have established state veterans cemeteries. Some states only have one cemetery while other states such as Hawaii offer as many as 8 different cemeteries. Eligibility is similar to Department of Veterans Affairs (VA) national cemeteries, but may include residency requirements. Even though state cemeteries may have been established or improved with government funds through VA's State Cemetery Grants Program, state veterans cemeteries are run solely by the states.
Motor Vehicles and License Plates
Motor vehicle registration, sales tax on a vehicle and license plates are generally free in those states where veterans are receiving disability grants from VA towards purchase or modification of a motor vehicle. In most states special design license plates identifying status, discharge or other service status of a veteran are available at no charge or additional charge. In most states, veterans who are disabled can receive license plates and registration for free.
Other Available Benefits
- free hunting or fishing licenses for disabled veterans
- free admission to state parks sometimes for all veterans but typically only for disabled veterans
- free copies of vital records for veterans making application for benefits
- free drivers licenses for disabled veterans
- free recording of discharge papers by county recorders
- free copies of certified discharge papers by county recorders
- tuition assistance for veterans, National Guard and dependents
- property tax exemptions for certain disabled veterans as well as for their widows
- partial property tax exemptions sometimes for any veteran but generally for those who are disabled
- one time grants and stipends for certain veterans or any veteran up to $3,000 in one state
- archiving of discharge records
- state income tax exemption for certain veterans or veterans recently discharged
- disability parking placards for disabled veterans
- honorary high school diplomas for World War 2 or Korean veterans
- in some states disabled veterans are exempt from payment of occupational taxes, administration fees, and regulatory fees imposed by local governments for peddling, conducting a business, or practicing a profession or semi profession.
The SVSA maintains a Current List of State Veterans Homes.
We have provided a current list of state veterans homes on this site. Click Here
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