omega overview of veteran services

OMEGA Care Planning Council,LLC

LTC Professional Case Management

OVERVIEW OF OMEGA AND VETERAN SERVICES

Compensation and Pension Service 2 Omega Care Planning Council

LTC Solutions for Veterans, Spouses and Care Providers

OMEGA KEY TEAM MEMBERS

Jerome Sebesta - CEO - OMEGA Care Planning Council.Jerome Sebesta is one of only 15 individuals in the state of NC that is Nationally VA Accredited Claims Agent for the Department of Veterans Affairs. Also a Medicaid Professional

Kimberly Damico – President ALPHA Wellness and SVP Omega, Masters in Clinical Mental Health Counseling, Natl VA Claims Agent.

Adam Weyer – Manager of Long Term Care Benefits, Claims Processing Team

Gerri Rife – LTC Operations Specialist

Rachel Wilkins – Office Administrator


Accredited Attorneys, Agents and Representatives Search Results

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Name City State Zip Phone Sebesta, Jerome Holly Springs NC 27540 919-557-0445

U.S. Department of Veterans Affairs - 810 Vermont Avenue, NW - Washington, DC 20420

Reviewed/Updated Date: May 10, 2010

BY LAW Reg.38 - All OMEGA Agents Must be VA Accredited with Department of Veterans Affairs.


Omega Care Planning Council

OMEGA Care Planning Council (Ten Years in Operation) is a single source

of professional advisers who help VETERAN families Navigate Long Term Care

Solutions. We strive to be the one stop provider for all of their Eldercare and Long

Term Care needs.


Our Services

Omega Care Planning Council understands that no long term care plan is single threaded. That's why we offer a wide array of options and solutions to these problems. Omega Team provides a highly unique group of Long Term Care Specialist including the following disciplines….. Helped over 2500 families!!


Long Term Care

Solutions and

Optimization

VA Benefit

s Elder Law

Reverse Mortgag

e

Mental Health

Age In Place Team

Medicaid

FulfillmentMedical

Home Renovatio

ns

Medicare

Benefit Options

Community

Placement

Nutritio

n

Entitlement

Specialist

Fiduciary and

Legacy Planning

Many Other

Disciplines


VA Benefits in Brief

Health Care

DisabilityCompensation Pension

Education &Training

Home LoanGuaranty

Life Insurance

Burial & MemorialBenefits


#1 Most Under-Utilized LONG TERM CARE BENEFIT = PENSION BENEFIT

11 million veterans and perhaps 20 million spouses qualify today for this benefit

ONLY 4.7% are actually receiving it93% of veterans and spouses do not

know that a VA benefit for LTC even exists!!!!

What it is NOT – It’s NOT Money that can be spent any way that the recipient likes – MUST BE SPENT FOR CARE

Pension


Potential Benefit = Long Term Care

$2,120/Month for Veteran and Spouse

$1,789/Month for Single Veteran$1,149/Month for Surviving

Spouse$1,404/Month for Protective

Environment (Vet is OK but Spouse is not)

Also a Housebound Benefit – One ADL = Can’t Drive 9


Eligibility Requirements

Veterans

Spouses

Surviving Spouse (Widow)

10


Service Requirements

90 Days Active Duty

One Day During War Time

Honorable, General or Medical Discharge

11


Age or Disability Requirement

Either Over Age 65 or

Totally Disabled (Social Security Definition) having ADLs

12


Periods of War

War or Conflict

Beginning & Ending Dates

World War II 12/7/1941—12/31/1946Korean Conflict

06/27/1950—01/31/1955

Vietnam Era 08/05/1964—05/07/1975; for veterans who served “in country” before 08/05/1964, 02/28/1961 to 05/07/1975

Gulf War 08/02/1990 through a date to be set by law or Presidential Proclamation


Need for Assistance with “Activities of Daily Living”

Cooking / EatingBathingToiletingFinancial ManagementHygieneBalanceMedication ManagementPresumptions (agent orange has

many…)Hospice.. Etc…


Benefit is Income and Asset Dependent

Income Test – Without our help or if claimants file on their own 9 out of 10 applications are denied by the VA due to Income Test

Asset Test – Without our help or if the claimants file on their own 5 out of 10 applications are denied by the VA due to Asset Test

OMEGA SOLVES THESE ISSUES THAT PREVENT VETERANS FROM OBTAINING

THIS BENEFIT!


Income Test9 out of 10 are Denied

OMEGA SOLVES THESE ISSUES THAT PREVENT OBTAINING THIS BENEFIT!

TOOLS WE USE:Care Agreements, Medical Expense

Spend Downs, Income Shifting Techniques, etc.


Asset Test5 out of 10 are denied

OMEGA IMPLEMENTS THE LEGAL TOOLS NECESSARY TO OVERCOME

THIS ISSUE!

TOOLS WE USE:Trusts, Promissory Notes, Gifting, Re-

deeding, Reverse Mortgages, Annuity Structuring, etc.


Income and Asset Solutions are Often Difficult but 99% Solve-able

Veterans do not get any advice on directing Income and Asset strategies and therefore can not take advantage of the VA Special Provisions within the regulation and get denied. (Solutions often require attorneys, investment advisors, etc). OMEGA is a Council of Disciplines.

VA has NO Look Back Period – Must position before the Claim is filed else it is denied.

Methods used to reposition income and assets MUST consider Medicaid 5 Year look back (Need to be Medicaid Certified and VA Accredited)

Often requires multiple disciplines such as Legal, VA, Investment and Medicaid “dove-tailed solutions” to difficult problems.

OMEGA OFFERS ALL THE DISCIPLINES NECESSARY TO OBTAIN THIS BENEFIT FOR VETERANS AND FAMILIES.


OMEGA Claim ProcessingThree Types

Informal Claim – Locks the Benefit DatePerfected Claim – Everything the

Adjudicator needs to decide the claim immediately– National Average = 15 months and files only

a Std Claim, – OMEGA timelines based on Priority Ranking:

• 15-45 days for Hospice Cases• 2-4 Months Veteran anywhere• 3-6 Months Surviving Spouse in Community• 9-12 Months Surviving Spouse at Home

Arrears Claim – One Year back - Informal date


There are a number of “Traditional Methods” to get VA Benefits…

Lawyer

Advisors /Family

Veteran Service Officer (VSO)


Why the “Traditional Methods” don’t work:

Lawyers are very expensive, sometimes charging $5,000+

Investment Advisors are after high commission positioning. Usually, causing more damage than it’s worth.

VSOs cannot legally advise veterans and surviving spouses on how to qualify.

Families that file on behalf of their loved one, find the VA regulation very confusing and give up due to its complexity and time commitments in developing the perfected claim.


OMEGA’s LTC Veteran Process

LTC StrategyConsultation

Work Performed

Strategy/ClaimPerfected

Implementation- VA Claim- LTC Plan

OMEGA is Fee Based - Fee is based on the work performed

PlanAcceptance

THIS EDUCATION MODULE1 Hour CE Credit -

Instructor

LTC Solution for VeteransIMPROVED PENSIONAid and Attendance

THANK YOU FOR ASSISTING OUR VETERAN FAMILIES

OMEGA Care Planning Council125 Edinburgh South Dr. #210Cary, NC. 27511919-552-3111www.omegacareplanningcouncil.org


Questions

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omega overview of veteran services

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