VA Health Care: Approaches for Developing Budget-Neutral Eligibility Reform

GAO discussed various proposals to reform eligibility for Department of Veterans Affairs (VA) health benefits. GAO noted that: (1) VA health care has evolved from a system primarily providing hospital care to veterans injured during wartime to a system focused on the treatment of low-income veterans with medical conditions unrelated to military service; (2) the eligibility provisions of the VA health care system are vague, provide uneven services, do not guarantee services, and cannot provide the total care that low-income veterans need; (3) while VA health care eligibility provisions should be reformed to better suit veterans' health care needs, none of the proposed legislation would be budget neutral; (4) present eligibility provisions do not cause inappropriate hospitalizations; (5) several legislative proposals to reform VA eligibility provisions would eliminate the restrictions on outpatient care and create a uniform benefit package, but inappropriate use of resources, uneven access, and some restrictions would continue to exist; (6) the proposed legislation to reform VA eligibility provisions would increase service availability, demand, and program costs; and (7) approaches for developing budget-neutral eligibility reforms include limits on covered benefits, limits on the number of veterans eligible, an increase in veteran cost-sharing, the authorization of recoveries from Medicare, VA retention of a portion of third-party recoveries, and reinvestment of savings from efficiency improvements.