VA MEANS TEST: By law VA is required to verify the self-reported gross household income (veteran, spouse and dependents, if any) of certain nonservice-connected or noncompensable 0% service-connected veterans to confirm the accuracy of their Eligibility for VA health care, Copay status, and Enrollment priority group assignment. VA verifies veterans' gross household income (spouse and dependents, if any) provided by the veteran on the financial assessment (means test). This financial information is verified by matching financial records maintained by the Internal Revenue Service (IRS) and the Social Security Administration (SSA). If the result of the income match reveals that the veteran's gross household income is higher than the established VA national means test threshold, the veteran will be contacted via mail to help resolve the income discrepancy. These contacts from VA gives the veteran and spouse the opportunity to dispute income as reported by IRS and SSA and/or reduce the total gross household income by providing proof of allowable deductible expenses
VA requires most veterans not receiving VA disability compensation or pension payments to provide information on their annual gross household income and net worth to determine whether they are below the annually-adjusted VA national means test threshold (income threshold), in order to qualify for exemption from outpatient, inpatient and medication copays. The financial assessment includes all gross household income and net worth, including Social Security, retirement pay, unemployment insurance, interest and dividends, workers' compensation, black lung benefits and any other gross household income. Also considered are assets such as the market value of property that is NOT the primary residence, stocks, bonds, notes, individual retirement accounts, bank deposits, savings accounts and cash. VA also compares veterans' financial assessments with geographically based income thresholds. If the veteran's income is above the VA national means test threshold and below the geographic means test (GMT) thresholds where the veteran lives, they are eligible for an 80% reduction in inpatient co-pay rates. For more information about geographically based income thresholds, go to the GMT eligibility page.
The veteran (and spouse if applicable) will be provided an opportunity to review the discrepancy between their reported income and the IRS and SSA data. If there is an error or other explanation for the discrepancy this information is provided by the veteran to VA for review. If we have not received a response from the veteran with 45 days, we will attempt to independently verify the total gross household income. This process entails us contacting all employers and financial institutions that reported income to the Internal Revenue Service and Social Security Administration. If no response is received from the veteran within 75 days, VA considers that due process requirements have been met and action is initiated to make appropriate eligibility, copay and enrollment status changes. Veterans subject to this process are individually notified by mail and provided with all related information. At the end of the income verification process, if it is determined that the veteran's gross household income is higher than the VA national means test income threshold:
- The veteran's priority group assignment will be changed.
- The veteran will be required to pay health care and medication copayments.
- VA health care facilities that provided care to the veteran will be notified to bill the veteran for services provided for their nonservice-connected conditions during the period covered by the income assessment.
- The veteran will be provided with due process/appeal rights
If the veteran is financially unable to pay the assessed copay charges, there are three options available:
1. Request a Waiver of Debt for the past debts you owe. A Waiver of Debt can be granted when there has been a significant change in income and the veteran has experienced significant expenses for medical care for the veteran or other family members, funeral arrangements or veteran educational expenses. A Waiver of Debt excuses all existing bills, but does not prevent future charges. A waiver must be requested in writing and by completing VA Form 5655, Financial Status Report. The request must specify each copayment for which a waiver is being requested. There is no limit on the amount that the veteran can request to be waived. The veteran must request a waiver in writing within 180 days from the date on the bill. To request a waiver, and for more information, contact the Revenue Coordinator at the VA health care facility where the veteran receives their care.
2. Request a Hardship Determination to prevent future billing. A Hardship Determination is an exemption from copay for a determined period of time. If a veteran's current year income is substantially reduced from the prior year, a veteran may request a Hardship Determination. Hardship Determination must be requested in writing. To request a Hardship Determination, contact the Enrollment Coordinator at the VA Medical Center where the veteran receives their care.
3. Request an Offer in Compromise. An Offer in Compromise is an offer for past debts only and acceptance of a partial payment in settlement and full satisfaction of the debt at the time the offer is made. VA will consider both the current and anticipated future income in making these determinations. Most Offers in Compromise that are accepted must be for a lump sum payment payable in full 30 days from the date of acceptance of the offer.
Offers in Compromise must be requested in writing and by completing VA Form 5655, Financial Status Report. There is no limit on the amount that the veteran can request for the Offer in Compromise. To request an Offer in Compromise, contact the Revenue Office at the VA Medical Center where the veteran receives their care.
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