Benefits

The Veteran's Choice Program Has Been Expanded

It was 2014 when the news story broke, and the public learned that the VA health care system was broken.  The scandal erupted in Phoenix, when whistleblowers revealed a secret wait list for veterans requesting care.  The list was hidden from Federal Regulators because the Phoenix VA sent regulators falsified documents that grossly underestimated the length of time veterans were waiting to be given a doctor’s appointment.  As the truth came to light, the public learned that Arizona veterans had to wait an average of 115 days to see a primary care doctor, and more than 40 veterans died waiting for care.

An investigation ensued, and regulators discovered that unreasonable wait times for doctor appointments was a pervasive problem throughout the VA system.  Why would VA hospital officials in Phoenix and other cities hide the fact that they did not have enough staff to provide care in a reasonable time frame?  It was all about money.  Hospital officials received pay bonuses for keeping wait times short.  Telling the truth would mean forfeiting those bonuses.  Hospital officials weren’t willing to do that.  As the investigation continued, more and more horror stories of back-logged appointments and untreated patients emerged.  Veterans died because they were unable to see a cancer doctor in a timely manner.  Patients with diabetes and kidney disease were going without treatment.  Suicidal veterans were turned away without care.

The Veterans’ Choice Program was Created.

In response to the public outcry, Congress passed the 2014 Veterans Access Choice and Accountability Act, more commonly known as the Veterans’ Choice Program.  President Obama promptly signed the Bill into law.   The program allowed those veterans who lived more than 40 miles from a VA hospital or who faced appointment wait times of more than 30 days to seek private care at the government’s expense. However, the program was limited and fiscally insecure.  It was set to run out of funds in late May or early June of this year.  The hope had been that the VA health care system would be repaired and ready to resume caring for all eligible veterans by 2018, but, of course, that never happened. 

As a result, a new Bill made its way through Congress.  In June, President Trump signed the VA Mission Act, a new law designed to update and expand the Veterans’ Choice Program, consolidating it with other programs into a single Veterans’ Community Care Program.  The new law provides more secure funding and expands eligibility.  The law also made the VA the primary coordinator for VCP benefits and removed barriers to sharing medical information with community providers.

Eligibility Requirements

To eligible for private care, the veteran must meet at least one of the program’s eligibility requirements listed below. 

  • The local VA medical facility tells you that it will be more than 30 days before you can see a health care provider.
  • You live more than 40 miles from the closest VA medical facility with a full- time primary care doctor.
  • You need to travel by air, boat, or ferry to the nearest VA medical facility.
  • You face an excessive or unusual burden in traveling to the nearest VA medical facility for your care. It may be due to geographical or environmental factors, due to your medical condition or other clinical factors. Staff at your local VA facility will meet with you to determine if you are eligible for private care.
  • You live in a state or U.S. territory that lacks a full-service VA medical facility that provides hospital care, emergency services, and surgical services, and you live more than 20 miles from such a facility. (For example: New Hampshire does not have a full-service VA facility, but some New Hampshire residents live within 20 miles of a facility located in an adjacent state).

How can veterans find out if they are eligible for the Veterans’ Choice Program?  Call the VCP call center at (866) 606-8198, or go to the Veterans’ Choice website at https://www.va.gov/COMMUNITYCARE/programs/veterans/VCP/index.asp.

Answers to Frequently Asked Questions

The program has generated some confusion with veterans being uncertain who to call and how to get prescriptions filled.  Some of the concerns raised are these:

  1. Can I call my non-VA doctor to make an appointment? No, you cannot.  Call the VCP at (866) 606-8198. The Veterans’ Choice Program will confirm your eligibility and make the appointment on your behalf.
  2. How is the 40 mile distance calculated? It is measured from your residence to the closest VA facility.  That includes both community VA clinics and VA Medical Centers.  You are eligible if you live more than 40 miles from a VA facility with a full-time primary care physician.
  3. If I am eligible for the VCP Program, can I receive Beneficiary Travel for travel to appointments with a VCP provider? If a veteran is already eligible for Beneficiary Travel, he or she will receive Beneficiary Travel benefits for appointments, but the program does not confer any new eligibility for the benefit.  (One of the chief criteria for the Beneficiary Travel Benefit is a service connected disability rating over 30).
  4. How do I get my prescriptions filled if I use the Veterans’ Choice Program?

a. The community provider you see through VCP can issue you a prescription for a 14-day supply of a drug.  You can have that prescription filled at any local pharmacy. 

b. You can be reimbursed for the cost of the 14-day supply through the Business Office/Non-VA Care Coordination Office at any VA facility.  To be reimbursed, you will need the original purchase receipt and a copy of the prescription.  The reimbursement process generally takes 30-45 days.  You cannot go to the VA pharmacy for reimbursement.

c. For prescriptions beyond the 14-day supply, you will need to follow standard procedures to fill a prescription at the VA pharmacy.

  1. What is my responsibilities for co-payments to my other insurance? The VA is the primary coordinator for the Veterans’ Choice Program, so you are responsible only for your VA copayment.  The VA will determine the amount of the copayment after the VCP care is provided and send you a bill for the copayment amount.

The VA Mission Act Also Assists Family Caregivers.

The new version of the Veterans’ Choice Program also expands eligibility for family members of disabled veterans to receive stipends for their role as caregiver.  Under the 2014, version, family members who were caregivers for severely disabled post 9/11 veterans were entitled to receive stipends for providing in home care. The revised law covers all severely disabled veterans, no matter when they served.  Providing caregiver assistance to family members is expected to save the VA money by allowing more disabled veterans to remain at home with family and avoid placement in a nursing home or group home.

In sponsoring the caregiver expansion, Senator Patty Murry said: “The more veterans and their caregivers who are eligible for support, the closer we are to fulfilling our promise to care for those who’ve sacrificed so much on our behalf.”  Her sentiment is echoed by most Americans who sincerely believe veterans deserve the best medical care we can provide.

Resources

www.va.gov/COMMUNITYCARE/programs/veterans/VCP/index.asp

www.va.gov/health/newsfeatures/2017/july/things-to-know-about-the-veteran-choice-program.asp

 

 

This website has been prepared for general information purposes only. The information on this website is not legal advice. Legal advice is dependent upon the specific circumstances of each situation. Also, the law may vary from state-to-state or county-to-county, so that some information in this website may not be correct for your situation. Finally, the information contained on this website is not guaranteed to be up to date. Therefore, the information contained in this website cannot replace the advice of competent legal counsel licensed in your jurisdiction.

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