Veterans Health
Administration Services
Hilary Edgerly, LCSW
Assistant Chief, Social Work Service
VA Illiana Health Care System, Danville, IL
Department of Veterans Affairs
 Three Administrations:
 Veterans Health Administration (VHA): Includes all
hospitals, clinics and Vet Centers
 Veterans Benefits Administrations (VBA): Oversees all
monetary benefits, including but not limited to disability,
education benefits, and life insurance
 Veterans Cemetery Administration (VCA): Operates all 131
National Cemeteries in the U.S. and Puerto Rico.
Service Connected v. Non Service
Connected
 Veterans with an injury or illness that they believe is
related to their military service can file a disability claim.
 Claims can be filed without assistance but it is
recommended that Veteran’s Service
Organizations(VSOs) Service Officers be utilized for
assistance in filing claims.
 Beware of individuals that charge a fee for filing claims!
 VSOs are organizations such as AMVETS, DAV, and
Illinois Department of Veterans Affairs.
Differences in general population
and Veterans needing a Guardian
 If Veterans were diagnosed with a serious mental illness
while in the military or within a year of discharge, they
can be rated disabled by the VA.
 Veteran rated 100%SC receives $2,816/month, not
including dependent pay or unemployability rating.
 Often, Veterans with a serious mental illness have very
large estates.
Basic Eligibility for General
Services
 Persons who served in the active military who were
discharged under conditions other than dishonorable
may qualify for VA heath care benefits.
 Reservist and National Guard members may also qualify
if they were called to active duty(other than for training
only) by a Federal order and completed the full period
for which they were called or ordered to active duty.
 Those Veterans who enlisted after 9/7/1980 or entered
active duty after 10/16/81 must have served 24
continuous months or the full period for which they were
called to active duty.
 This requirement may not apply to Veterans discharged for
hardship, early out or a disability incurred or aggravated in
the line of duty.
Enrollment
 Veterans must apply for services.
 Complete VA Form 10-10EZ, Application for health Benefits.
Available at any VA facility or at www.va.gov/1010ez.htm
 Four categories are not required to enroll.
 Veterans with a service-connected(SC) disability of 50% or
more.
 Veterans seeking care for a disability the military determined
was incurred or aggravated in the line of duty but has not yet
been rated by VA (only within 12 months of discharge).
 Veterans seeking care for a service-connected disability only
(this does not happen very often).
 Veterans seeking registry examinations (Ionizing Radiation,
Agent Orange, Gulf War/Operation Iraqi Freedom(OIF) and
Depleted Uranium).
Priority Groups
 The number of veterans who can be enrolled in the
health care program is determined by the amount of
money Congress gives VA each year. Since funds are
limited, VA set up priority groups to make sure that
certain groups of veterans are able to be enrolled before
others.
Priority Groups
 During enrollment, each Veteran is assigned to a priority
group.
 Priority groups are used to balance demand for VA
health enrollment with resources.
 Currently, VA is able to serve Veterans in groups 1-7
with a subgroup in 8 that can also be served if they
agree to pay copays.
Priority Groups
 Group 1: Veterans with SC disabilities rated 50% or
more and Veterans determined by VA to be
unemployable due to SC conditions.
 Group 2: Veterans with SC disabilities rated 30-40%
 Group 3: Veterans with SC disabilities rated 10-20%;
Veteran who are former POWs or awarded Purple Heart
medal or the Medal of Honor; Veteran awarded special
eligibility for disability incurred in treatment or
participation in VA Vocational Rehabilitation program;
and Veterans whose discharge was for a disability
incurred or aggravated in the line of duty.
 Group 4: Veterans receiving aid and attendance or
pension benefits and/or Veterans determined by VA to
be catastrophically disabled.
Priority Groups
 Group 5: Veterans receiving VA pension benefits or
eligible for Medicaid, and non-service connected (NSC)
Veteran and non-compensable, zero % SC Veterans
whose gross annual income and/or net worth are not
greater than the VA financial thresholds.
 Group 6: Veterans seeking care solely for certain
conditions associated with exposure to ionizing radiation
during certain periods; Project 112/SHAD participants;
Veterans with compensable 0 % SC disabilities; Veterans
who served in Republic of Vietnam between 1/9/625/7/75 or SW Asia theater of operations from 8/2/9011/11/98; and Veterans who served in a theater of
combat operations after 11/11/98 as follows:
 Veterans discharged on or after 1/28/2003.
Priority Groups
 Group 7: Veterans with incomes below the geographic
means test income and who agree to co-pays.
 Group 8: Veterans with gross household income above
the VA national income threshold and geographicallyadjusted income threshold who agree to pay co-pay.
 Group 8 is broken into sub-priorities that are somewhat
complicated. VA cannot serve some Veterans at this time
with high income without another eligibility factor.
 If they were enrolled as of 1/16/03 and continuously stayed
enrolled, they will continue to be eligible for care with copays.
 If they were enrolled on or after 6/15/09 but are within
10% of the income threshold, they are eligible with copays.
Eligibility for OEF/OIF/OND
Combat Veterans: 5 years cost
fee health care.
 OEF/OIF/OND combat Veterans can receive cost free
medical care for any condition related to your service in
the Iraq/Afghanistan theater for 5 years after the date of
your discharge or release
 This includes 5 years (post-discharge) cost-free health
care for any injury or illness associated with combat
service
 After the 5 year period ends, VA care and treatment will
continue
 At that point, Veteran could be responsible for co-pays
that are based on your income and eligibility
 But first the Veteran must enroll into VA health
care!
OEF/OIF/OND Veterans
 Other Injuries
 Veterans who have non-combat related or non-service
connected illnesses/injuries may be charged a co-pay for
these conditions dependent on income level
 Determined officially by VA
 For example, flu, colds, auto accident, etc.
 A Time Sensitive Free Benefit
 VA offers free dental benefits for evaluation and treatment
for recently discharged Veterans
 Veterans may qualify for these benefits if he/she meets
both of the following requirements:
 served more than 90 days of continued service, and
 DD214 does not show that they received all needed dental
service at least 90 days prior to your separation
 Note: Veterans must apply for this dental care within 180
days (6 months) of separation from active duty service.
Co-payments
 Veterans 50% SC and higher have no co-pays for any
medical care received at the VA.
 Veterans 10-40% SC have no copay for appointments but
may be required to make medication copays dependent on
their income.
 VA can and will bill third party insurance for any visit that is
not SC related.
 Inpatient copays vary dependent on services provided and
Veterans priority group.
 Outpatient copays are as follows:
 Primary Care Services: $15
 Specialty Care Services: $50
 Medications: $8-$9 dependent upon income level of Veteran
Mental Health Services
 Remember, not every Veteran who has sustained injuries
in combat has PTSD. Trauma impacts all individuals
differently. Grief and adjustment are normal reactions
to injury.
 VA offers a wide range of services for PTSD which
include:
 Seeking Safety
 Prolonged Exposure Therapy
 Cognitive Processing Therapy (group or individual)
 CBTI (for insomnia)
 PAIRS (for couples)
 Support Groups
 Residential treatment programs available regionally
Mental Health Services
 Mental health counseling is available for a wide range of
diagnoses at both VAMC and community based outpatient
clinics (CBOCs).
 Acute Psychiatric inpatient services are available at most
VAMCs, as well as Residential Rehabilitation Treatment
Programs.
 RRTP units can be general mental health rehabilitation. Some
VA’s offer specialized units for certain diagnoses.
 Services are provided by Licensed Individual Practitioners
but primarily LCSWs, Psychologists, Psychiatrists, Physician
Assistants and Nurse Practitioners.
 VA has Evidence Based Therapy Coordinators at each
VAMC. Goal is to have all staff who perform counseling to
be trained (certified if possible) in some form of EBT.
 VA is also working with community partners to expand the
network of therapists available for Veterans with mental
health treatment needs.
 Local Recovery Coordinators have also been hired at each
VA with the goal to have all treatment recovery focused
rather than problem focused.
Other mental health services
available…
 Therapeutic Supportive
Employment Services
 Homeless Outreach and
Case Management
 Residential Care Homes
 Health behaviors/disease
prevention programs
 Pain Management
 Mental Health Intensive
Case Management
 Substance Abuse
Rehabilitation Program
 Primary Care Mental
Health Integration
 Peer Support
 Suicide Prevention
Program
 Neuropsychology
 Readjustment Counseling
at Vet Centers
Therapeutic and Supported
Employment Services
 Includes Compensated Work Therapy (CWT) programs
(Supported Employment, Transitional Work, Sheltered
Workshops, and Veterans Construction Team), Incentive
Therapy, and Vocational Assistance.
 The TSES programs are based on a recovery-oriented
model and offer a continuum of work restoration
services.
 Veterans are financially compensated for their work and
in turn, improve their economic and social well-being as
they prepare for community re-entry.
Health Care for Homeless
Veterans (HCHV)
 HUD/VASH: Housing and Urban Development/VA
Supported Housing. HUD vouchers are distributed to
Housing Authorities throughout the country for permanent
housing for chronically homeless Veterans.
 Outreach: Two Social Workers are traveling our area daily
to link Veterans with Community Resources and reach out
to Homeless Veterans who are not receiving care through
the VA.
 Substance Use Disorders: This program works with Veteran
who are Homeless but also have substance use disorders,
providing housing while supporting recovery.
 Grant and Per Diem Program: Semi-permanent housing for
Veterans. VA contracts with community partners and pays
a daily per diem for each Veteran housed in their facility.
There is a clinical component to all contract Grant and Per
Diem Programs.
Peer Support
 Peer Specialists and Peer Support Apprentices are a
unique cadre of people joining VA’s mental health care
teams.
 They are Veterans who have successfully dealt with their
own mental health recovery for a minimum of one year.
Peer Specialists are trained and certified, while Peer
Support Apprentices are undergoing training and
certification to become Peer Specialists.
 VA has hired over 800 Peer Specialists and Peer Support
Apprentices since 2012.
Readjustment Counseling
Services
 Vet Centers are located in all 50 states, the District of
Columbia, Guam, Puerto Rico, and America Samoa.
 They are separate from the hospitals and clinics.
Sometimes Veterans will be afraid to go to the VA but
are more comfortable receiving services from a Vet
Center.
 Veterans are eligible if they served on active duty in a
combat theater or area of hostility during World War II,
the Korean War, the Vietnam War, the Gulf War, or the
campaigns in Lebanon, Grenada, Panama, Somalia,
Bosnia, Kosovo, Afghanistan, Iraq and the Global War on
Terror. Veterans, who served in the active military during
the Vietnam-era, but not in the Republic of Vietnam,
must have requested services at a Vet Center before
Jan. 1, 2004.
 Vet Centers do not require enrollment in the VHA Health
Care System.
Prosthetics
Veterans receiving VA
care for any condition
may receive VA
prosthetic appliances,
equipment and
services. Veterans who
are approved by VA for
a guide or service dog
may also receive
service dog benefits
including some
veterinary care and
equipment.
 Home respiratory therapy
Hearing aides and
eyeglasses have special
eligibility.
 Walkers
 Artificial limbs and recreation
equipment.
 Orthopedic braces and
therapeutic shoes
 Wheelchairs
 Powered mobility (must be
approved by team)
 Crutches
 Canes
 Special aids, appliances, optical
and electronic devices for visual
impairment
 Other durable medical
equipment and supplies
Extended Care
 Different eligibility criteria apply for Long Term Care
(Nursing Home Care).
 Only Veterans who are 70% SC or greater, 60% SC and
unemployable, or require nursing home care due to a SC
condition are eligible for LTC to be paid for by VA.
 LTC can be provided in a contracted community nursing
home with VA payment, in a VA Community Living Center
(including Green Houses) or in a State Veterans Home.
 In some special circumstances, those not meeting this
criteria can be placed for short-term stay but could be billed
up to $97 per day based on the Application for Extended
Care Services (VA Form 10-10EC). Placement under
another payment source must occur upon completion of
goal of VA paid treatment or expiration of authorization for
treatment.
Extended Care: Green Houses
Liberty and Freedom
 THE GREEN HOUSE® Project offers a model for longterm care designed to look and feel like a real home.
Over the last decade Green House homes have set a new
standard for quality care with a model that is both
proven and practical.
 VA Illiana Health Care System has two Green Houses.
Each House offers 10 Veterans long-term care in a
home-like setting.
 The first homes were opened in 2012 and construction
began on two additional homes this year. The two
additional homes should open in Summer 2015.
 The first homes require Veterans to meet LTC guidelines
(70-100%SC or 60% and rated unemployable).
 New homes will offer Dementia Care and Short
Stay/Rehabilitation/Skilled Care.
Green House Project Video
 http://thegreenhouseproject.org/videos#28
Extended Care: CLC
 Community Living Centers offer skilled nursing services
at the VA medical center.
 70-100% SC or 60% SC and rated unemployable are
eligible for indefinite stay.
 Specialized care: Palliative Care Unit, Alzheimer’s and
Related Disorders Unit, Geri-Psych Units, Rehabilitation
 Interdisciplinary team consisting of Provider, RN, Social
Worker, Psychologist, Pharmacist, Dietician, PT, OT, SLP,
KT and RT.
 Veterans not meeting LTC criteria can be admitted,
pending bed availability for short-stay (less than 90
days). May be co-pay required. Social Workers assist
with discharge planning to community via other payer
sources.
Extended Care: CNH
 Veterans who are LTC eligible can choose to receive their
nursing home care in a Contract Nursing Home.
 Each VA has Contracts with community nursing homes,
allowing the Veteran to receive care closer to their
home/family.
 VA Social Workers and Nurses visit the Veterans in the
CNH monthly for case management, coordination of
care, and assessment of psychosocial needs.
 CNH are paid a daily per diem rate. Follow-up care is
arranged at the VA or in some pre-authorized cases with
community hospitals and providers.
 Special Authorization for CNH is approved for Veterans
at End of Life or Veterans whose caregiver is in need of
respite (30 days per year).
Extended Care: NIC
 Non-Institutionalized Care: Veterans
are eligible for NIC services based on
need as determined by the
interdisciplinary team.
 Home Based Primary Care
 Contract Adult Day Care
 Homemaker/Home Health Aide Service
 Bowel and Bladder Care
 Home Skilled Nursing
 Medical Foster Home
 Respite Care
Extended Care: HBPC
 Home Based Primary Care is VA’s version of visiting
nurses.
 An interdisciplinary team sees the Veteran in the Home.
RN sees the Veteran every two weeks. Other disciplines
(Social Work, Dietician, KT, Psychology, Provider) visit
Veteran on a prn basis, but at least annually.
 This program is a great resource for Veterans whose
physical condition makes it difficult to travel to the VA
Hospital or Clinic for appointments.
Extended Care: CRC
 Community Residential Care is a partnership between VA
and caregivers in the community who are willing to
invite Veterans into their home.
 CRC is a VA sponsored program that provides health
care supervision to Veterans who do not require
hospitalization or nursing home care.
 These Veterans are not able to live independently
because of their medical or psychiatric diagnoses. Their
families cannot provide personal assistance or
supervision.
 Two types: Residential Care Homes and Medical Foster
Homes
Extended Care: CRC
 In both RCH and MFH, agreement is made between the
VA and the caregiver/sponsor to become an approved
home.
 Each home is inspected and approved by the VA, but the
Veteran pays for the care.
 RCH is typically for Veterans requiring less physical care
but may need prompting, cues, reminders, etc. Most
Veteran’s in RCH have a psychiatric diagnosis.
 MFH is more appropriate for Veteran’s with need for
physical assistance. Homes only take 3 or less Veterans.
All Veterans in MFH also receive HBPC services.
Caregiver Programs and Services
 Caregivers are vital partners in the treatment of
Veterans and Service Members.
 Each VAMC has a Caregiver Support Coordinator to
facilitate caregiver activities and serve as a resource
expert.
 Programs available for all Veteran Caregivers: In-home
and community based care (skilled RN, H/HHA, CADHC,
HBPC), respite care (in-home and nursing home),
caregiver education and training programs, and family
support services.
Caregiver Programs and Services:
Caregivers and Veterans Omnibus
Health Services Act of 2010
 To be eligible, Veterans must have had a serious injury
incurred or aggravated in the line of duty on or after
9/11/01.
 Provides benefits to a parent, spouse, child, step-family
member, extended family member or an individual who lives
with the Veteran but is not a family member.
 Benefits include:
 Monthly stipend based on the personal care needs of the
Veteran
 Travel, lodging and per diem for training
 Health Care Insurance through CHAMPVA
 Mental Health Services
 Comprehensive training
 Respite care
 Respite care during training
 Appropriate caregiving instruction and training
Dental Insurance
 Dental Services have different eligibility requirements.
 100% SC Veterans are the only Veterans eligible for VA
dental benefits other than some special populations of
Veterans such as homeless Veterans and Veterans rated by
VA to have a service related dental injury.
 VA’s Dental Insurance Program (VADIP) offers enrolled
Veterans and beneficiaries of VA’s Civilian Health and
Medical Program (CHAMPVA) the opportunity to purchase
dental insurance at a reduced cost. VA is offering this
service through Delta Dental and MetLife.
 VADIP is a three-year, national pilot program to assess the
feasibility and advisability of providing a premium-based
dental insurance plan to eligible individuals. The program is
mandated by Public Law 111-163, Caregivers and Veterans
Omnibus Health Services Act of 2010.
 Veterans enrolled in the VA health care program and
CHAMPVA program beneficiaries are eligible to participate in
VADIP. Participation in VADIP will not affect Veterans’
eligibility for VA dental services and treatment.
VA and ACA
 If a Veteran is enrolled in VA health care, the Veteran does
not need to take additional steps to meet the health care
law coverage standards. The health care law does not
change VA health benefits or Veterans’ out-of-pocket costs.
 If a Veteran chooses to cancel his/her VA health care
enrollment, he/she may reapply for enrollment at any time;
however, acceptance for future VA health care enrollment
will be based on eligibility factors at the time of application,
which may result in a denial of enrollment.
 If a Veteran is not enrolled in VA health care, he/she can
apply at any time
 Family members are a key part of Veterans good health and
support network. VA health care coverage is available for
family members of certain Veterans who are permanently
and totally disabled or died serving our country and in some
cases, Veterans with children who have Spina Bifida.
 Veterans can have private insurance and VA health care
benefits concurrently.
For more information:
 Crisis Line: 1-800-273-TALK
 VA Health Eligibility Center: 1-877-222-VETS (8387)
 VBA Call Center: 1-800-827-1000
 www.va.gov
 www.va.gov/health/aca/
 http://thegreenhouseproject.orrg
References
 Public Law 111-163, Caregivers and Veterans Omnibus
Health Services Act of 2010
 www.va.gov
Any questions?