VA Health Care:

Offsetting Long-Term Care Costs by Adopting State Copayment Practices

HRD-92-96: Published: Aug 12, 1992. Publicly Released: Aug 12, 1992.

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Pursuant to a congressional request, GAO provided information on Department of Veterans Affairs (VA) efforts to offset the costs of providing nursing home and domiciliary care by increasing charges to veterans, focusing on the recovery of some costs from the estates of veterans or their survivors.

GAO found that: (1) states have implemented or increased copayments for state veterans home residents to avoid deficits and home closings; (2) VA has not focused on increasing veterans copayment amounts to offset mounting costs; (3) in 1990, VA offset $260,389, or less than one-tenth of 1 percent of its budget; (4) a 4-percent copayment increase would have saved VA $43 million, and a 43-percent increase would have saved $464 million; (5) state homes require over 90 percent of veterans to contribute copayments, and grant fewer exemptions; (6) VA homes require veterans to contribute about 1 percent and exempt veterans more frequently than state homes; (7) states require veterans to make higher copayments than VA homes and community nursing homes; and (8) safeguards to prevent nursing home charges from causing financial hardship on veterans or their families involve not requiring veterans to sell their homes, granting personal needs allowances, and protecting spouses from impoverishment.

Matters for Congressional Consideration

  1. Status: Closed - Not Implemented

    Comments: Congress expanded eligibility for VA health care without increasing cost-sharing for long-term care benefits. There are no indications that further consideration will be given to expanded cost sharing.

    Matter: Congress may wish to consider changing the current policy for charging veterans for care in VA and community facilities to help offset increased operating costs, fund care for more veterans, or both.

  2. Status: Closed - Not Implemented

    Comments: Congress expanded eligibility for VA health care without increasing cost-sharing for long-term care benefits. There are no indications that further consideration will be given to expanded cost sharing.

    Matter: Congress may wish to consider changing the copayment requirements by discontinuing automatic exemptions for certain types of veterans.

  3. Status: Closed - Not Implemented

    Comments: Congress expanded eligibility for VA health care without increasing cost-sharing for long-term care benefits. There are no indications that further consideration will be given to expanded cost sharing.

    Matter: Congress may wish to consider increasing the amount of the copayment by instituting a higher fixed-rate copayment or a variable-rate copayment based on the veteran's ability to pay. Any change in the law should be accompanied by adequate safeguards to help prevent placing an undue financial hardship on the veterans or their families.

 

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