The VA must provide the Medical Benefits Package—hospital care and outpatient care services—that are defined as “needed.” VA defines “needed” as care or service that will promote, preserve, and restore health. This includes treatment, procedures, supplies, or services. This decision of need will be based on the judgment of the veteran’s healthcare provider and in accordance with generally accepted standards of clinical practice.
No veteran may obtain VA health care benefits unless he or she is enrolled in VA’s system of patient enrollment. Veterans are automatically entitled, however, to benefits within the 12-month period following their discharge without the necessity of enrolling. The Department of Veterans Affairs must furnish hospital care and medical care to enrolled veterans at the nearest facility, or, if no Veterans Affairs facility is near-by, at a facility with which VA has a con-tractual relationship, on the basis of Enrollment Priority Groups. There are eight priority groups:
Priority Group 1
- Veterans with service-connected disabilities rated 50 percent or more disabling
Priority Group 2
- Veterans with service-connected disabilities rated 30 percent or 40 percent disabling
Priority Group 3
- Veterans who are former POWs
- Veterans awarded the Purple Heart
- Veterans whose discharge was for a disability that was incurred or aggravated in the line of duty
- Veterans with service-connected disabilities rated 10 percent or 20 percent disabling
- Veterans awarded special eligibility classification under Title 38, U.S.C., Section 1151, “benefits for individuals disabled by treatment or vocational rehabilitation”
Priority Group 4
- Veterans who are receiving aid and attendance or housebound benefits
- Veterans who have been deter-mined by VA to be catastrophically disabled
Priority Group 5
- Nonservice-connected veterans and noncompensable service-connected veterans rated 0 per-cent disabled whose annual in-come and net worth are below the established VA Means Test thresholds
- Veterans receiving VA pension benefits
- Veterans eligible for Medicaid benefits
Priority Group 6
- World War I veterans
- Mexican Border War veterans
- Veterans solely seeking care for disorders associated with:
- exposure to herbicides while serving in Vietnam; or
- exposure to ionizing radiation during atmospheric testing or during the occupation of Hiroshima and Nagasaki; or
- for disorders associated with service in the Gulf War;
- for any illness associated with service in combat in a war after the Gulf War or during a period of hostility after November 11, 1998; or
- compensable 0 percent service-connected veterans
Priority Group 7
- Veterans who agree to pay specified copayments with income and/or net worth above the VA Means Test threshold and income below the HUD geographic index
- Subpriority a: Noncompensable 0 percent service-connected veterans who were enrolled in the VA Health Care System on a specified date and who have remained enrolled since that date
- Subpriority c: Nonservice-connected veterans who were enrolled in the VA Health Care System on a specified date and who have remained enrolled since that date
- Subpriority e: Noncompensable 0 percent service-connected veterans not included in Subpriority a above
- Subpriority g: Nonservice-connected veterans not included in Subpriority c above
Priority Group 8
- Veterans who agree to pay specified copayments with income and/or net worth above the VA Means Test threshold and the HUD geographic index
- Subpriority a: Noncompensable 0 percent service-connected veterans enrolled as of January 16, 2003, and who have remained enrolled since that date
- Subpriority c: Nonservice-connected veterans enrolled as of January 16, 2003, and who have remained enrolled since that date
- Subpriority e: Noncompensable 0 percent service-connected veterans applying for enrollment after January 16, 2003
- Subpriority g: Nonservice-connected veterans applying for enrollment after January 16, 2003
Exceptions to these priorities are permitted for “compelling medical reasons.” Within these priorities, VA must give special priority to the specialized treatment and rehabilitative needs of disabled veterans with spinal cord dysfunction, blindness, amputations, and mental illness by furnishing distinct programs or facilities as needed.
Resources:
- Disability Compensation (VA.gov)
- Health Care Benefits (VA.gov)
- Education Benefits (VA.gov)
- Guide to Other VA Benefits (VA.gov)
- VA Aid & Attendance
- VA Benefits A-Z
- VA Home and Community Based Services
- Check your VA claim or appeal status
