VA Health Care:

Potential for Offsetting Long-Term Care Costs Through Estate Recovery

HRD-93-68: Published: Jul 27, 1993. Publicly Released: Jul 27, 1993.

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Pursuant to a congressional request, GAO reviewed the potential for the Department of Veterans Affairs (VA) to recoup the costs of providing nursing home and domiciliary care through an estate recovery program, focusing on: (1) the potential estimated savings; (2) program procedures that prevent undue hardships on affected veterans' family members; and (3) options for program administration.

GAO found that: (1) although VA has the authority to recover unpaid nursing home copayments through estate recoveries, it does not have the same authority as states to recover the remaining costs for nursing home and domiciliary care or prevent asset transfers between veterans and family members to avoid future recovery; (2) a significant portion of VA nursing home and domiciliary care costs could be offset if VA had similar collection authority as states; (3) estate recovery programs can be structured to recover costs without placing undue hardships on the elderly, are consistent with the government's commitment to provide medical care to veterans, and can recover significantly more costs than they incur; (4) recovery of nursing home and domiciliary care costs through an estate recovery program has greater potential for veterans than for Medicaid recipients because veterans generally have greater assets and larger estates; (5) the success of the Oregon Medicaid estate recovery program should serve as a model for a VA estate recovery program; and (6) the implementation of a VA estate recovery program would not be difficult, since an administrative framework is already present and elderly advocacy groups generally accept the program because it protects recipients and their families from undue hardships.

Status Legend:

More Info
  • Review Pending-GAO has not yet assessed implementation status.
  • Open-Actions to satisfy the intent of the recommendation have not been taken or are being planned, or actions that partially satisfy the intent of the recommendation have been taken.
  • Closed-implemented-Actions that satisfy the intent of the recommendation have been taken.
  • Closed-not implemented-While the intent of the recommendation has not been satisfied, time or circumstances have rendered the recommendation invalid.
    • Review Pending
    • Open
    • Closed - implemented
    • Closed - not implemented

    Matters for Congressional Consideration

    Matter: Congress may wish to consider authorizing VA, like state Medicaid agencies, to recover up to the full costs it incurs to provide nursing home and domiciliary care from the estates of veterans who received care. These funds could be used to help offset increased operating costs, fund care for more veterans, or both.

    Status: Closed - Not Implemented

    Comments: Discussions have been held with staff from the House Budget Committee's working group on national security issues, the Subcommittee on Human Resources and Intergovernmental Relations, House Committee on Governmental Reform and Oversight, and the House Committee on Veterans' Affairs. The use of estate recovery was presented to the Veterans' Affairs committees as one option for offsetting the costs of eligibility expansions. No specific legislative proposals have been introduced.

    Matter: To implement an effective program, Congress may wish to consider giving VA authority--similar to Medicaid--to preserve veterans' estates by preventing asset transfers to family members or others that would circumvent cost recovery.

    Status: Closed - Not Implemented

    Comments: No specific legislative proposals have been introduced, but discussions have been held with staff from the House Budget Committee's working group on national security issues, the Subcommittee on Human Resources and Intergovernmental Relations, House Committee on Governmental Reform and Oversight, and the House Committee on Veterans' Affairs.

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