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Publication Briefs

Study Shows Inequities in Enhanced Pension Benefit for Veterans

VA’s Veterans Benefits Administration (VBA) supports a large population of older Veterans who require long-term care through the Aid and Attendance enhanced pension benefit (A&A) – a monthly cash benefit available to older, low-income Veterans who require assistance meeting daily needs. But a 2004 VA study estimated that less than one-third of Veterans who received a pension and were potentially eligible for A&A received it. This observational study examined sociodemographic, medical, and healthcare use characteristics associated with the receipt of A&A among Veterans receiving pension. Using VA and Medicare administrative data, investigators sought to: 1) identify Veterans’ predisposing, enabling, and need characteristics associated with receipt of A&A; and 2) determine how A&A receipt among pensioners varies by VA medical center, suggesting differences in access. The final cohort included 89,845 Veterans who received pension benefits in FY16 and FY17, but not A&A in FY16.


  • This study identified potential inequities in Veterans’ receipt of the A&A enhanced pension. Among 89,845 Veterans who received a pension but not the A&A enhanced benefit in FY2016, 8,724 Veterans (10%) newly received the A&A enhanced pension in FY2017.
  • Veteran pensioners who received A&A were significantly older and more likely to be white and married than those who did not receive A&A. Pensioners who were black, Hispanic, or other non-white race had a lower probability of receiving A&A than white Veterans after adjusting for indicators of need.
  • Most indicators of need for assistance (e.g., home health use, dementia, stroke) were associated with significantly higher probabilities of receiving A&A, with notable exceptions: pensioners with PTSD or enrolled in Medicaid had lower probabilities of receiving A&A.
  • Among Veterans receiving pension, receipt of A&A varied by medical center.


  • While provider education and wider dissemination of information about A&A may help reduce observed inequities, action is required at the system level that will eliminate the possibility of bias in which some eligible pensioners are able to access this enhanced pension benefit and others are not.


  • Administrative data did not allow investigators to examine some predisposing, enabling, and need characteristics (e.g., caregiver availability, education, health literacy).
  • Investigators were only able to identify Veterans who were receiving A&A among those receiving pension; thus, were unable to determine who had sought benefits but had not received them or Veterans who may be eligible for A&A but not yet receiving pension benefits.

Dr. Thomas was funded through an HSR&D Career Development Award (CDA 14-422). Dr. Thomas and Ms. Corneau are part of HSR&D’s Center of Innovation in Long-Term Services and Supports for Vulnerable Veterans (LTSS). Dr. Van Houtven is with HSR&D’s Center of Innovation to Accelerate Discover and Practice Transformation (ADAPT).

Thomas K, Corneau E, Van Houtven C, et al. Inequities in Access to VA’s Aid and Attendance Enhanced Pension Benefit to Help Veterans Pay for Long-Term Care. Health Services Research. February 25, 2021; Online ahead of print.

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What are HSR Publication Briefs?

HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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