Who is eligible for care through the VA?
While the VA provides a wide range of programs and services, the eligibility for care is not “one size fits all.” You and your veteran should speak to an eligibility coordinator at a local VA health care facility to talk about your specific situation. The most important document to bring to the VA is the veteran’s DD Form 214. Typically, eligibility for VA health care is based on previous military service, presence of service-connected disabilities, and other factors. Normally veterans must enroll in the VA health care system to receive medical care, and once enrolled, he or she will be assigned to one of eight priority categories.
If your veteran was deployed in support of Operation Iragi Freedom (OIF) or Operation Enduring Freedom (OEF), he or she automatically is eligible for VA health care for five years. A very important contact for recent veterans is the OIF/OEF/OND case manager. All VA medical centers have at least one. They screen the veteran for case management and other VA services, assist in navigating the facility, answer questions about VA care, and identify other appropriate resources. Most veterans who have been in their service’s warrior-care program while still on active duty (for example, Marine’s Wounded Warrior Regiment, Army Wounded Warrior Program, etc.) will be assisted in enrolling in Veterans Health Administration (VHA) as part of transition planning. Recovery care coordinators and other service representatives are available to assist your veteran through their recovery and transition to the VA, including VA health care.
What is care coordination?
Not all enrolled veterans obtain all of their health care services from the VA. Veterans may rely solely on the VA for their care or may receive their health care services from other sources, such as Medicare, Medicaid, private health insurance, and the military health care system, including the TRICARE civilian network. Veterans also might have a care plan that includes services and care from some or all of these sources. This is not uncommon, as the VA does not have all of the necessary resources that usually are required for the complex care required for some veterans.
How does my veteran get his initial enrollment appointment at the VA?
If a veteran is enrolled in the VA for health benefits, call the local VA health facility to schedule an appointment.
When a veteran's enrollment application is approved, an appointment will be scheduled. It can be requested on the application or you can call for an enrollment appointment. Generally, veterans will receive notification in writing of the appointment and eligibility for medical care. The enrollment coordinator at your local facility will have details if you have questions or concerns.
You can fill out all the enrollment paperwork prior to the discharge date on the DD Form 214, but the request for an initial appointment will not be processed until the date on the DD Form 214 is reached. The first VA medical center appointment is usually an initial physical exam. This must be done before any subsequent appointments will be scheduled or referrals for specialty care will be made.
The appointment waiting times for both primary care and specialty care may vary greatly. If you do not receive satisfactory notification in a timely manner, do not hesitate to call back. If extended appointment times remain, or if the local or another close-by VA medical center is unable to provide a specific needed service or test, the veteran’s VA physician will make a referral for “fee basis” care in the community. The VA makes this referral and pays the community provider for the care. If your veteran is not referred out for fee basis care when the physician determines it is needed, ask to speak with the facility’s patient advocate to assist with the referral.
Will the VA bill me for the care provided the veteran?
VA-enrolled veterans do not pay premiums or enrollment fees to receive care from the VA. Health care for a service-connected medical condition is free for veterans. However, the veteran for whom you care for may incur out-of-pocket costs for VA care related to conditions that are not service-connected.
Also, veterans might incur bills for copayments for their health care from the VA or outside entities during the initial phases of their care with the VA (prior to the determination of their service-connected disability rating). These bills will arrive at the veteran’s home address for care received until his or her VA disability rating is determined. (For those in the Integrated Disability Evaluation System process, this is the rating with all the provisional language removed.) You must hand carry this finalized rating into records at the local VA medical center to ensure it is recorded for billing purposes. The Veterans Benefits Administration will not send a copy to the VHA. Please ensure your address is current.
In cases where these bills will be prolonged and might start to accumulate, contact the VA to obtain a waiver of payment or a delay of payment where it might create a hardship. Discuss this with the VA medical center billing office and the veteran’s case manager.
Enrollment in the VA health care system meets the requirement for having health care coverage under the Affordable Care Act (ACA), which went into effect Oct. 1, 2013. Additional information on the ACA and the VA can be found on the VA website or by calling (877) 222-VETS (8387).
What rehabilitative services does the VA offer?
The VA provides a variety of rehabilitative services for veterans, with the goal of improving their quality of life and providing greater independence. Unfortunately, these services are not located at every VA medical center. To find out where these are located and whether they would be right for the veteran for whom you care, talk with your health care team, which usually consists of a primary care physician, a case manager, or, for recent veterans, the OIF/OEF program manager at your local VA (every VA health facility has a social worker in this role who will screen the veteran for case management services and facilitate entry to the VA medical facility).
The VA website can provide information to an array of specific rehabilitative services but confer with your care team first for more specific information.
Several of the services the VA has (not a conclusive listing) are: