VA Health Care:

Issues Affecting Eligibility Reform

T-HEHS-95-213: Published: Jul 19, 1995. Publicly Released: Jul 19, 1995.

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GAO discussed the issues affecting the Department of Veterans Affairs' (VA) health care eligibility reforms, focusing on the: (1) differences between eligibility for VA health care and the eligibility under typical public and private health insurance programs; (2) problems VA's eligibility provisions create for veterans and providers; (3) efforts to reform VA eligibility; and (4) options for offsetting the costs of eligibility expansions. GAO noted that: (1) veterans' eligibility for VA health care has evolved over time; (2) VA has gone from a system that provides hospital care for veterans with war-related injuries to a system that covers a wide array of medical services for all veterans; (3) eligibility for VA health care has grown complex and includes multiple categories for veterans based on period of service, seriousness of service-connected disability, and income; (4) veterans' eligibility continues to be based on their need for hospital-related care; (5) unlike other public and private insurance programs, there are no guaranteed benefits under the VA health care system; (6) the provision of VA health services is conditioned on the availibility of space and resources; and (7) alternative approaches for restructuring VA health care eligibility include eliminating the restrictions on access to ambulatory care, creating an uniform benefit package, expanding veterans' entitlement to free care, and changing the VA funding structure.

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