State RegulationsVA specificDifficulty 3/5
Two long-term care claimants are evaluated in Virginia. One cannot perform several activities of daily living without help; the other is physically capable but has severe cognitive impairment and wanders away from home. How should their claims be assessed under Virginia's benefit-trigger standards?
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Answer & full 3-part explanation (select an option above, or peek)
Why C is correct
Virginia's benefit-trigger standard under 14 VAC 5-200-187 is deliberately two-pronged. Functional triggers cover the insured who needs substantial assistance with activities of daily living; cognitive triggers cover the insured whose severe cognitive impairment — as in dementia with wandering — requires substantial supervision for protection. Neither prong outranks the other, and a claimant with intact physical function but severe cognitive impairment satisfies the cognitive prong just as the physically limited claimant satisfies the functional one.
Why the other options are wrong
- A) Cognitive impairment is an express trigger prong, not an exclusion; the wandering claimant can qualify.
- B) There is no physical-loss-only requirement; substantial supervision for severe cognitive impairment stands on its own as a trigger.
- D) Cognitive triggers do not take priority; the two prongs are parallel, not ranked.
Memory hook
Two doors to LTC benefits: hands that can't manage the activities, or a mind that needs watching.