Veterans Affairs: Actions Needed to Improve Access to Care in the U.S. Territories and Freely Associated States
Fast Facts
VA provides health care and other benefits to veterans in the U.S., its 5 territories, and 3 Pacific countries known as the freely associated states.
VA estimates the size of the veteran population to allocate resources but is unsure if estimates are accurate for veterans in territories and freely associated states. Some local stakeholders have found the estimates to be low. Veterans in these areas must travel long distances for specialty care at VA facilities and many don't qualify for VA's travel benefits. Our recommendations help address these and other issues.
VA Medical Center in Honolulu, Hawaii
Highlights
What GAO Found
In addition to serving veterans in the 50 U.S. states and District of Columbia, the Department of Veterans Affairs (VA) is responsible for providing health care and other benefits to veterans in the three foreign countries in the Pacific collectively known as the freely associated states (FAS) and in the five U.S territories.
U.S. Territories and Freely Associated States and Their Distances from Washington, D.C.
VA uses a model to estimate the size of the veteran population to inform resource allocation and outreach needs. However, VA lacks assurance that the model's estimates are accurate for territory and FAS veterans—for example, one major data source for the model does not include data on most of these locations. Further, local stakeholders from these areas consistently stated that VA's estimates were low. Assessing the model's data sources and availability of other data sets, and making changes as appropriate, could help VA ensure the accuracy of its data for the territories and FAS.
Additionally, VA efforts have not sufficiently addressed veterans' access to care challenges in the territories and FAS. For example, due to VA's eligibility criteria for its travel benefits program, as of March 2024, FAS veterans and a large portion of territory veterans do not qualify for VA travel benefits, though they generally need to travel long distances to access VA care. Regarding FAS veterans, legislation enacted in March 2024 explicitly authorized VA subject to certain agreements to reimburse them for travel related to eligible health care services, but VA has not yet implemented this legislation. Additionally, the enabling law that authorized VA to reimburse certain veterans' travel also authorized VA to make payments to any person not explicitly covered in the law, pursuant to regulations. VA may be able to improve access to care for veterans living in the territories by assessing whether it is feasible and advisable to expand eligibility for certain veterans in these areas, as well as by amending its regulations as appropriate.
Why GAO Did This Study
Citizens from the U.S. territories and FAS generally enlist in the military at higher per capita rates than some U.S. states. As veterans, they are eligible for certain VA benefits. However, GAO has previously found that veterans living in the remote Pacific U.S. territories and abroad can face unique and sometimes substantial challenges accessing their VA benefits.
The Honoring our PACT Act of 2022 includes a provision for GAO to review veterans' access to their benefits in the U.S. territories and FAS. This report examines, among other objectives, how VA estimates the population of veterans in the U.S. territories and FAS and VA efforts to help address challenges these veterans face accessing VA health care services.
GAO conducted site visits to all five territories and Hawaii, reviewed documentation, and interviewed officials from VA and DOD program offices as well as from local and regional offices of each of these agencies. GAO analyzed data such as veteran demographics and health care service utilization. GAO also interviewed non-federal stakeholders, such as FAS embassy staff.
Recommendations
GAO is making five recommendations to VA and one to DOD. These include recommendations that VA assess (1) the data sources in its model for estimating the veteran population in the U.S. territories and FAS and (2) its travel benefits policies for territory veterans and amend its regulations as appropriate. VA and DOD concurred with GAO's recommendations and identified steps the departments will take to address them.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Veterans Affairs | The Secretary of VA should assess the underlying data sources of its VetPop model to identify the extent to which known data limitations impact the accuracy of population estimates for veterans living in the U.S. territories and FAS. In doing so, VA should consult with local government officials and stakeholders to identify and validate available veteran data sources, and make changes as appropriate to VetPop's data sources. (Recommendation 1) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|
| Department of Veterans Affairs | The VA Under Secretary for Health should clearly communicate in writing appropriate uses for the new capabilities within its VHA Support Service Center databases to generate utilization and timeliness of care data by veteran location. (Recommendation 2) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
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| Department of Veterans Affairs | The Secretary of VA should assess whether it is feasible and advisable to expand travel reimbursement eligibility for any condition among service-connected disabled veterans in the U.S. territories, and as appropriate or consistent with that analysis, amend its regulations to do so. (Recommendation 3) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
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| Department of Veterans Affairs | The Secretary of VA should ensure that the Director of VAPIHCS, in collaboration with DOD, identify and implement additional opportunities to share resources and solutions to address shared challenges affecting the implementation of their resource sharing agreements in the Pacific. (Recommendation 4) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
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| Department of Veterans Affairs | The VA Under Secretary for Health, in coordination with the Executive Directors of the VA Office of Procurement, Acquisition, and Logistics, and the VHA Procurement and Logistics Office, should clarify in writing the appropriate processes, in line with VHA's Supply Chain Management Operations Directive, for VA Caribbean Healthcare System officials to communicate challenges receiving medical services or devices. (Recommendation 5) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
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| Department of Defense | The Secretary of DOD should ensure that the Directors of the Defense Health Networks Indo-Pacific and Pacific Rim, in collaboration with VA, identify and implement additional opportunities to share resources and solutions to address shared challenges affecting the implementation of their resource sharing agreements in the Pacific. (Recommendation 6) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
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