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January 31, 2019

Get ready: New VA policy could triple the number of veterans eligible for private-sector care

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    The Department of Veterans Affairs (VA) on Wednesday proposed new access to care standards that would give veterans greater access to VA-funded care at private health care providers.

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    President Trump in 2018 signed a bill (S 2372) to revamp the Veterans Choice Program (VCP), which aims to increase veterans' access to health care by providing them with federally subsidized care at non-VA facilities. The law directs VA to streamline programs that allow veterans to seek care from private health care providers, while expanding regulations that dictate when veterans are permitted to seek care at non-VA facilities.


    VA proposes new access standards

    Under current regulations, veterans who live more than 40 miles from a VA facility or have to wait more than 30 days for an appointment at a VA facility are permitted to seek VA-funded care from private providers.

    However, VA on Wednesday proposed increasing those eligibility thresholds to include veterans who have to:

    • Drive 60 minutes or more to receive specialty care from a VA facility;
    • Drive 30 minutes or more to receive primary or mental health care from a VA facility;
    • Wait more than 28 days to receive specialty care from a VA facility; or
    • Wait more than 20 days to receive primary or mental health care from a VA facility.

    Under the proposed standards, veterans with certain urgent care needs also could use VA-approved walk-in clinics run by private health care providers. VA in a release said veterans who use the clinics might be charged a copayment.

    VA officials said the percentage of veterans eligible for VA-funded private health care services would increase from about 8% annually to about 20 to 30%. VA proposed implementing the new requirements in June, and is currently seeking public comments on the proposal.


    Some observers have criticized the proposed standards, saying they would lead to a dramatic increase in veterans seeking community care, which could drain VA's funds.

    For example, a group of more than two dozen Democratic senators in a letter sent Wednesday to VA Secretary Robert Wilkie wrote that the proposed standards would "significantly increase the overall cost and amount of care VA will send to the community." They wrote, "Given that the [Trump] administration opposes increasing overall federal spending, these increased costs for community care will likely come at the expense of VA's direct system of care. And that is something we cannot support."

    Over the past year, there has been a lot of debate about whether the administration would seek to privatize the VA health system. While some observers argue the latest proposal could serve as a first step toward privatization efforts, Wilkie in a statement rejected such claims. He said, "Here are the facts: under … Trump, VA is giving veterans the power to choose the care they trust, and more veterans are choosing VA for their health care than ever before." Wilkie added, "Most Americans can already choose the health care providers that they trust, and … Trump promised that veterans would be able to do the same. With VA's new access [rules], the future of the VA health care system will lie in the hands of veterans—exactly where it should be" (Slack, USA Today, 1/30; Steinhauer, New York Times, 1/30; VA release, 1/30).

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