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Health Care for Veterans

Health Care for Veterans

Health Care for Veterans

In 1996, Congress enacted the Veterans’ Health Care Eligibility Reform Act of 1996 to expand, update, and simplify the eligibility rules for Veterans Administration (VA) health care. The Act further expands the provision of outpatient care for veterans. In addition, the Act allowed for the establishment of a Medical Benefits Package, a health benefits plan available to all enrolled veterans.

The Act requires the VA to provide “needed” hospital care and outpatient benefits to enrolled veterans. The VA defines “needed” as care or service that will promote, preserve, and restore health. This includes treatment, procedures, supplies, or services.


The decision of what services are needed is made by a veteran’s health care provider in conjunction with acceptable medical standards. The Medical Benefit Plan provides a wide array of services, including inpatient and outpatient medical, surgical and mental health care, including treatment of substance abuse; emergency care in VA facilities; emergency care in non-VA facilities under certain conditions; rehabilitation services; and home health services. In addition, the Medical Benefit Plan provides for preventative care such as periodic check-ups and preventative mental health and substance abuse services.

In order to take part in the Medical Benefits Plan, veterans must enroll with the VA. To be eligible for enrollment, veterans must have “veteran status:” active duty service in the military, naval, or air service and a discharge or release from active military service under other than dishonorable conditions. Some veterans who entered service after September 7, 1980 or October 16, 1981 are required to have completed 24 months of continuous active military status to achieve veteran status. Enrollment must be renewed on an annual basis. Three categories of veterans do not need to enroll to participate in the Medical Benefits Plan. They are: veterans with a service-connected disability of 50 percent or more; those discharged less than one year prior for a disability incurred or aggravated in the line of duty and who have not yet been rated by the VA; and those who are seeking VA care only for a service-connected disability.

After a veteran has been deemed eligible for enrollment, he or she is assigned a priority group, ranging from 1 to 8. The priority groups are designed to help the VA manage the provision of services within the budgetary limitations. Priority group 1, for veterans with service-connected disabilities rated 50 percent or more disabling, is the highest priority rating. Priority groups 7 and 8, the two lowest priority ratings, require copayments from veterans with sufficient income or net worth.

Copyright 2011 LexisNexis, a division of Reed Elsevier Inc.

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