3.) “The possible adverse effects of the proposed legislation should also, I believe, be considered. VA has gradually shifted from a system primarily providing treatment for veterans with service-connected disabilities incurred in wartime to a system increasingly focused on the treatment of low-income veterans with medical conditions unrelated to military service. 4.) VA Eligibility Provisions Frustrate Veterans and Limit VA’s Ability to Meet Veterans’ Health Care Needs

Unlike public and private health insurance, the VA health benefits program does not (1) have a well-defined benefit package or (2) entitle veterans to, or guarantee the availability of, covered services. Our review, however, found little basis for linking most inappropriate hospitalizations to VA eligibility provisions. Proposed Bills Would Eliminate Restrictions on Outpatient Eligibility, but Other Problems Would Continue

Eligibility reform proposals introduced during the past year would eliminate the restrictions on veterans’ access to outpatient care. Limit the Number of Veterans Eligible for VA Health Care

Another way to develop budget-neutral eligibility reform would be to pay for expanded eligibility for some veterans by restricting or eliminating eligibility for others. These include increased cost sharing, authorizing recoveries from Medicare, and allowing VA to retain funds from third-party recoveries. VA has historically used savings from efficiency improvements to fund new programs. Key Provisions of Selected Proposals to Reform Eligibility for VA Health Care

This appendix contains a synopsis of the key provisions in the four major eligibility reform bills introduced during the past year. 1385) would, on a temporary basis for the period ending September 30, 1999, expand the mandatory care category for comprehensive outpatient medical treatment to include all veterans in the mandatory care category for hospital care (core group) other than those with noncompensable service-connected disabilities (nursing home and dental services would remain discretionary); require VA to expand its capacity to provide outpatient care and allocate resources to its facilities in a way that would give veterans access to care that is reasonably similar regardless of where they live; include preventive health services and prosthetic appliances in the definition of services that are provided to core group veterans; include home health services in the definition of services that may be provided to core group veterans; authorize the Secretary of Veterans Affairs to use systems of patient prioritization and to set up a system of enrollment of eligible veterans; allow VA to retain a portion of third-party recoveries to expand outpatient require VA to ensure that any veteran with a service-connected disability is provided all benefits to which he or she is entitled.
Why GAO Did This Study

GAO discussed various proposals to reform eligibility for Department of Veterans Affairs (VA) health benefits.

What GAO Found

GAO noted that: (1) VA health care has evolved from a system primarily providing hospital care to veterans injured during wartime to a system focused on the treatment of low-income veterans with medical conditions unrelated to military service; (2) the eligibility provisions of the VA health care system are vague, provide uneven services, do not guarantee services, and cannot provide the total care that low-income veterans need; (3) while VA health care eligibility provisions should be reformed to better suit veterans' health care needs, none of the proposed legislation would be budget neutral; (4) present eligibility provisions do not cause inappropriate hospitalizations; (5) several legislative proposals to reform VA eligibility provisions would eliminate the restrictions on outpatient care and create a uniform benefit package, but inappropriate use of resources, uneven access, and some restrictions would continue to exist; (6) the proposed legislation to reform VA eligibility provisions would increase service availability, demand, and program costs; and (7) approaches for developing budget-neutral eligibility reforms include limits on covered benefits, limits on the number of veterans eligible, an increase in veteran cost-sharing, the authorization of recoveries from Medicare, VA retention of a portion of third-party recoveries, and reinvestment of savings from efficiency improvements.