Financial Assessment (Means Test)
Most Veterans who do not receive a VA disability or pension payment or have a VA special eligibility, such as a recently discharged Combat Veteran, must completeVA Form 10-10EZ, Application for Health Benefits. These Veterans must provide information on their prior income year total gross household income (click here link to income info) and net worth to determine enrollment status, and copay responsibility for VA health care and/or prescription medication. Total gross household income includes income of the Veteran, spouse and dependent children.
In order to ensure the availability of quality and timely health care to Veterans with service connected conditions, special authority based on military service, low income, and those with special health care needs, in January 2003 VA made the difficult decision to stop enrolling new Priority Group 8 (high income) Veterans whose income exceeded VA Income Thresholds.
The new regulations went into effect on June 15, 2009 and enable the Department of Veterans Affairs (VA) to relax income restrictions on enrollment for health benefits. While this new provision does not remove consideration of income, it does increase income thresholds. You may be eligible for enrollment under this new provision.
- VA is required by law to verify Veterans’ self-reported household income. The Income Verification (IV) is a process VA uses to match Veterans’ self-reported household income with the Internal Revenue Service (IRS) and Social Security Administration (SSA). Veterans subject to this process are Veterans who receive free medical care and/or medications based on their self-reported income.
- If a Veteran’s self reported income is below VA’s income thresholds but the income information received from IRS/SSA indicates income above VA’s income threshold, the Veteran and spouse, if applicable, will be notified by letter and given an opportunity to verify or dispute this information. The VA Income Verification Office Benefits Case Managers will assist the Veteran in reviewing all documents including those that may further reduce the Veterans’ reported total gross household income using authorized deductions. If the submitted information does not reduce the Veteran’s self-reported income below VA’s income threshold, the copay status will be changed and the Veteran will be required to pay applicable copays for care received.
- If the Veteran is financially unable to pay the assessed copay charges, there are options (waiver, compromise or repayment plan) available through the Veteran’s servicing VA healthcare facility or by telephone at 877-222-VETS (8387).
- Because of the timeframe for taxpayers to report income to the IRS, the IV process typically begins in July of the following year of reported income. For example, income for the 2010 income year will not be available from IRS/SSA until July of 2011.
Income Verification Communication Timeline
- IRS/SSA report indicates income discrepancies.
- Initial notification to the Veteran and Spouse (if applicable).
- Veteran mailed an initial notification letter and a reminder letter within 45 days if no response, offering the opportunity for the Veteran to verify or dispute the income reported by IRS/SSA and to submit additional deductible expenses, if any.
- An IV Benefits Case Manager will be assigned to work with the Veteran and/or the Veteran’s representative once a response is received. The Case Manager will provide assistance and guidance to the Veteran through the income verification process. It is our goal to work closely with the Veteran to resolve and close the income verification case within 75 days.
If no response is received within 75 days, it is assumed the IRS/SSA information is correct and a letter will be sent informing the Veteran that his/her copay status will be changed and of their copay responsibility.