Rule published for VA net worth, health care eligibility

Rule published for VA net worth, health care eligibility

The VA announced earlier this year that it will end the use of certain veterans’ net worth as a determining factor for eligibility for VA health care programs and copayment responsibilities. Now, it has published the proposed rule in the Federal Register to amend the VA net worth regulation for Priority Category 5 health care enrollment eligibility.

Rule published for VA net worth, health care eligibilityThe proposed amendment, published on October 20, 2015, would remove the “regulatory provision restating the VA’s discretionary authority to consider the net worth of a veteran’s assets when determining eligibility for lower-cost health care.”

The VA uses priority categories to determine which Veterans are eligible to enroll in the VA health care system and the amount of copayments Veterans must pay for VA medical benefits. Veterans not eligible for enrollment in priority categories 1 through 4 but are “unable to defray the expenses of necessary care” are placed in category 5. Generally, this means the veteran is low income, eligible to receive State medical assistance, has a service-connected disability or qualifies for a VA pension.

Currently, the VA can use net worth as part of the criteria to determine whether the veteran is “unable to defray the cost of care.” However, the law does not make the use of net worth in health care priority group eligibility determinations mandatory.  In January 2015, the VA made a policy decision to stop considering net worth of veterans’ assets for eligibility determinations in Category 5.  This proposed amendment would remove the language from the regulation, matching current policy and practice to regulation.

Expected outcomes:

  • Veterans do not have to provide net worth of their assets, reducing time, effort and paperwork to the VA
  • A reported estimate of 53,000 veterans would be moved from lower health care categories up to Category 5
  • A reported estimate of 135,000 veterans that were previously ineligible would become eligible to enroll in the VA health care system over the next five years (this is down from an earlier estimate of 190,000)
  • The VA will not have to spend time and effort interpreting subjective values and verifying the net worth of assets information (annual income is still verified).

Review the full explanation and the proposed regulation changes at Comments can be submitted through in response to ‘‘RIN 2900–AP37—Removing Net Worth Requirement from Health Care Enrollment.’’ Comments are due on or before December 21, 2015.

The statute and implementing regulations for the VA health care enrollment system are 38 USC 1705, 38 CFR 17.36, and 38 CFR 17.47.