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Means Test And Geographic-based Means Test Thresholds For


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Department of Veterans Affairs VHA DIRECTIVE 2005-064

Veterans Health Administration

Washington, DC 20420 December 22, 2005

MEANS TEST AND GEOGRAPHIC-BASED MEANS TEST THRESHOLDS FOR

CALENDAR YEAR 2006

1. PURPOSE: This Veterans Health Administration (VHA) Directive provides the Means Test

Thresholds, Medicare Deductible Rate, and Child Income Exclusion for calendar year 2006. In

addition, this Directive provides an internet link to the United States (U.S.) Housing and Urban

Development’s (HUD) income limits for Fiscal Year (FY) 2005 for use by VHA in calendar year

2006.

2. BACKGROUND

a. Title 38 United States Code (U.S.C.) Section 1722© requires that on January 1 of each

year, the Secretary of Veterans Affairs increase the means test threshold amounts by the same

percentage the maximum rates of pension benefits were increased under 38 U.S.C. Section

5312(a) during the preceding calendar year. Under the provisions of 38 U.S.C. Section 5312, the

Department of Veterans Affairs (VA) is required to increase the benefit rates and income

limitations in the pension and parents' Dependency and Indemnity Compensation (DIC) Program

by the same percentage and effective date as increases in the benefit amounts payable under Title

II of the Social Security Act.

b. On November 10, 2005, the Veterans Benefits Administration (VBA) announced that

effective December 1, 2005, veterans’ benefits will receive an increase of 4.1 percent.

c. Public Law 107-135, the Department of Veterans Affairs Health Care Programs

Enhancement Act of 2001, directed VA to implement a Geographic-based Means Test (GMT)

(see 38 U.S.C. Section 1705(a)(7)). VA uses HUD’s "low-income" geographic-based income

limits as the thresholds for VA’s GMT. NOTE: The Health Eligibility Center (HEC) controls

the GMT for VA; as such, HEC will install Patch IVMB*2.0*867 before January 1, 2006. A

veteran’s income from the previous year is compared with the appropriate GMT threshold for the

previous fiscal year to determine if the veteran should be placed in priority category 7. The "low

income" geographic-based income thresholds for FY 2005 can be found at:

http://www.va.gov/healtheligibility/costs/docs/GMTIncomeThresholds2005.pdf

d. Definitions

(1) "Below the means test threshold." "Below the means test threshold" is defined as

those veterans whose attributable income and net worth are such that they are unable to defray

the expenses of care; therefore, they are not subject to co-payment charges for hospital and

outpatient medical services. Within the Veterans Health Information Systems and Technology

Architecture (VistA) system such veterans are designated as "Means Test Copay Exempt."

THIS VHA DIRECTIVE EXPIRES DECEMBER 31, 2006

VHA DIRECTIVE 2005-064

December 22, 2005

2

(2) "Above the means test and GMT threshold." "Above the means test and GMT

threshold" is defined as those veterans whose attributable income and net worth are such that

they are able to defray the expenses of care; therefore they must agree to pay a co-payment for

hospital care and outpatient medical services. Within the VistA system these veterans are

designated as "Means Test Copay Required."

(3) "Above the means test and below the GMT threshold." "Above the means test and

below the GMT threshold," is defined as those veterans whose attributable income and net worth

are such that they are able to defray the expense of care, but whose inpatient medical care copayments

are reduced 80 percent. Within the VistA system these veterans are identified as

"GMT Copay Required."

3. POLICY: It is VHA policy that all VA health care facilities must install patch DG*5.3*686,

EAS*1.0*69, IVMB*2.0*867 and IB*2.0*331 before January 1, 2006. NOTE: The new means

test, net worth, and GMT threshold rates are effective January 1, 2006.

4. ACTION

a. Medical Facility Director. Before January 1, 2006, each medical facility Director, or

designee, is responsible of installing patch DG*5.3*686, EAS*1.0*69, IVMB*2.*0*867 and

IB*2.0*331. NOTE: The new means test and GMT threshold rates are effective January 1,

2006.

b. Means Test Thresholds. The following new Means Test Thresholds are effective

January 1, 2006, through December 31, 2006:

(1) Veterans with No Dependents

(a) Below Means Test Threshold: $26,902.

(:D Above Means Test Threshold: $26,903.

(2) Veterans with One Dependent

(a) Below Means Test Threshold: $32,285.

(:) Above Means Test Threshold: $32,286.

(3) Veterans with Two Dependents

(a) Below Means Test Threshold: $34,091.

(:blink: Above Means Test Threshold: $34,092.

VHA DIRECTIVE 2005-064

December 22, 2005

3

(4) Veterans with Three Dependents

(a) Below Means Test Threshold: $35,897.

(B) Above Means Test Threshold: $35,898.

(5) Veterans with Four Dependents

(a) Below Means Test Threshold: $37,703.

(B) Above Means Test Threshold: $37,704.

(6) Veterans with Five Dependents

(a) Below Means Test Threshold: $39,509.

(B) Above Means Test Threshold: $39,510.

c. Dependent Threshold Amount Increase (above two dependents): $1,806.

d. Child Income Exclusion: $8,450.

e. Medicare Deductible: $952.

f. Income and/or Asset threshold for Net Worth Development: $80,000.

g. Maximum Annual Rate of Pension: Base rate.

(1) The base rate is $10,579. NOTE: The base pension rate is also used to determine if

certain veterans are subject to co-payments for Extended Care Services.

(2) The base rate with one dependent is $13,855.

(3) Add $1,806 for each additional dependent.

5. REFERENCES

a. Title 38 U.S.C. Sections 1705(a) (7) and 1722.

b. Title 38 Codes of Federal Regulations (CFR) Sections 17.36(B)(7), 17.47(d), and 17.47(f).

c. VHA Directive 2003-005, Implementation of Geographic Means Testing and Revised

Inpatient Co-payments Requirements.

VHA DIRECTIVE 2005-064

December 22, 2005

4

6. FOLLOW-UP RESPONSIBILITY: The Chief Business Office (16) is responsible for the

contents of this Directive. Questions may be addressed to 202-254-0406.

7. RESCISSIONS: VHA Directive 2004-071 is rescinded. This VHA Directive expires

December 31, 2006.

S/Jonathan B. Perlin, MD, PhD, MSHA, FACP

Under Secretary for Health

DISTRIBUTION: CO: E-mailed 12/23/05

FLD: VISN, MA, DO, OC, OCRO, and 200 – E-mailed 12/23/05

Source: http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1363

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