The Promise and Challenges of VA Community Care

by Petra Rasmussen, Carrie M. Farmer: For Complete Post, Click Here…

Despite an overall decline in the U.S. veteran population, the number of veterans using VA health care has increased. To deliver timely care to as many eligible veterans as possible, VA supplements the care delivered by VA providers with private-sector community care, which is paid for by VA and delivered by non-VA providers. Although community care is a potentially important resource for veterans facing access barriers and long wait times for appointments, questions remain about its cost and quality. With recent expansions in veterans’ eligibility for community care, accurate data are critical to policy and budget decisions and ensuring that veterans receive the high-quality health care they need.

Factors Determining Veterans’ Eligibility and Priority for VHA Benefits

Veterans must first meet basic criteria to be eligible for VHA benefits.

  • When military service began
  • Duration of military service or active-duty service (for reserve and National Guard members)
  • Conditions of discharge from the military
  • Service-related conditions (e.g., disability, military sexual trauma)

Eligible veterans are assigned to 1 of 8 priority groups.

  • Determines when a veteran is eligible for benefits and to what extent they contribute to the cost of their care
  • Factors considered:
    • Military service history
    • Disability rating
    • Income level
    • Eligibility for Medicaid
    • Other benefits received (e.g., VA pension benefits)

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