VA Enhanced Monthly Benefits:

Recipient Population Is Changing, and Awareness Could Be Improved

GAO-12-153: Published: Dec 14, 2011. Publicly Released: Jan 13, 2012.

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Daniel Bertoni
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What GAO Found

According to VA data during fiscal years 2000 to 2010, most enhanced monthly benefit recipients were veterans, over age 65, and receiving the A&A enhancement as part of their pension benefit. The recipient population is changing, however. In particular, the percentage of enhanced monthly benefit recipients age 65 or younger increased from 18 percent to 24 percent over the decade. Also, the percentage of recipients paid benefits under the disability compensation program increased from 15 percent to 26 percent. The cost of enhanced monthly benefits has increased from $124 million in fiscal year 2000 to $409 million in fiscal year 2010; however, VA does not know what portion of these costs was paid specifically for A&A and Housebound benefits. VA maintains data on enhanced monthly benefit recipients’ total payments but does not separately identify the amount awarded as an A&A or Housebound benefit. VA officials stated that under its current system, separately tracking the costs of these benefits would be complicated and difficult.

Enhanced monthly benefits helped veterans obtain services to perform everyday living activities in different ways, but high service costs and limited service availability in some areas can make it difficult to acquire the services. Benefit recipients GAO spoke with said that they used their benefits to pay for in-home services by private providers, offset lost income from family members who provided care for them, or defray the costs of an assisted living facility. However, obtaining services from private providers can still pose difficulties for some recipients because of the generally higher cost of services in large urban areas or the limited availability of services in rural areas.

VA conducts a number of outreach activities to educate veterans and their family members about available benefits; however, a large number of elderly veterans may not be aware of their potential eligibility for enhanced monthly benefits. A VA study found that of pension recipients—who are mainly elderly veterans—62 percent might be eligible for enhanced monthly benefits but only 22 percent received them, which the study primarily attributed to lack of awareness about the benefits. VA’s outreach efforts may not be sufficient to inform elderly veterans about enhanced monthly benefits because outreach activities do not typically focus on these benefits, some printed material lacks information on eligibility and application requirements for these benefits, and the extent to which regional offices conduct elderly outreach varies, among other reasons.

Why GAO Did This Study

The Department of Veterans Affairs (VA) offers Aid and Attendance (A&A) benefits to individuals who need regular assistance and the attendance of another person or Housebound benefits to individuals who are substantially confined to their homes. These benefits, which increase recipients’ monthly disability compensation or pension payments, are called enhanced compensation or enhanced pension, respectively—collectively referred to as enhanced monthly benefits. This report describes (1) characteristics of enhanced monthly benefit recipients; (2) how the benefits help veterans obtain needed services, and the associated difficulties they face in obtaining these services; and (3) VA’s efforts to educate veterans and their family members about the availability of the benefits. GAO’s work included analyzing VA case-level demographic data from fiscal years 2000 to 2010 on enhanced monthly benefit recipients, conducting facilitated focus groups with veterans and their family representatives, and interviewing VA headquarters and regional officials on VA’s outreach efforts for enhanced monthly benefits, as well as reviewing relevant federal laws and regulations.

What GAO Recommends

GAO recommends that VA conduct more focused outreach to better educate potential recipients about enhanced monthly benefits. VA agreed with the recommendation and described a number of actions it would take or explore to address it, such as including more detailed information in its printed material on enhanced monthly benefits.

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Recommendation for Executive Action

  1. Status: Closed - Implemented

    Comments: In November 2012, VA stated that VBA updated the 2012 Federal Benefits for Veterans, Dependents and Survivors handbook (published in August 2012) with detailed language on enhanced monthly benefits, and continued to publicize and promote awareness of Aid and Attendance and Housebound benefits via periodic Facebook and Twitter postings, which it began in December 2011. VBA stated that it determined that a direct mailing targeted to those veterans and survivors in receipt of pension benefits to inform them of the eligibility for enhanced monthly benefits was not feasible. However, it incorporated detailed language about enhanced monthly benefits into the 2013 cost-of-living adjustment letter. They also posted a fact sheet on enhanced monthly benefits on their web site in September 2012. Regarding performance goals, VA stated that VBA's Benefits Assistance Service (BAS) established an internal performance goal to increase all outreach efforts by 10 percent for FY 2013, which would be the baseline for FY 2012 outreach data. With respect to providing guidance on elderly outreach and the specific duties of outreach coordinators, VA stated that its BAS conducted national awareness training in June 2012 through a national conference call for elderly outreach coordinators, and continued to conduct monthly conference calls with these coordinators starting in October 2012. In addition, VA stated that BAS provided guidance to the field offices on outreach efforts to elderly veterans during the Pension and Fiduciary Service monthly conference call and the Compensation Service monthly conference call, both in August 2012. To provide more detailed guidance, BAS also published the M27-1, Benefits Assistance Service Procedures Manual in September 2012.

    Recommendation: To enable VA to improve its efforts to educate veterans and their family members about enhanced monthly benefits, the Secretary of VA should direct the Undersecretary for Benefits to take steps to conduct more focused outreach to potential recipients, which could entail the following: 1) improving communication of and accessibility to information about enhanced monthly benefits. Such efforts could include (1) providing more information in the VA benefits handbook and other informational material on VA benefits, (2) increasing the visibility of links on VA's website to information about these benefits, and (3) using local or national broadcast and print media to disseminate information about these benefits. 2) Continuing efforts to establish specific performance goals and metrics for increasing outreach to elderly veterans. 3) Providing more detailed guidance to regional offices on how elderly outreach should be conducted and on the specific duties of outreach coordinators.

    Agency Affected: Department of Veterans Affairs


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