I am new on the forum and just want to clarify - are you referring to 58 home health aide hours? l am a VA social worker as well as the wife of someone with ALS. Typically, you can't "double dip" benefits with anything Federal. Meaning, you can't duplicate services with VA, Tricare or Medicare because they're all Federal. If someone has private health insurance, Medicaid or long term care insurance, in theory you might be able to get more hours. I think in any state someone who is 100% service connected will exceed income threshold for Medicaid eligibility. Have you asked your neurologist if they can advocate for you to get more hours? I know of one case where the Veteran (did not have ALS) did get an exception to policy for a couple more hours a week.