Enrollment Restrictions
Background
By law, the Secretary of Veterans Affairs is required to review, on an anual basis, the patient enrollment system. The purposeof this review is to ensure that adequate resources are available to provide quality and timely health care to all enrolled veterans. When the demand for services exceeds VA's ability to provide such care, the Secretary is required to make enrollment adjustments.
Demand for VA Health Care
The demand for VA health care has seen a dramatic increase in the past several years. Because of the rapid growth on demand, VA has been unable to provide all enrolled veterans timely access to quality health care. The growth also resulted in veterans being placed on waiting lists for appointments to see a medical care provider.
Decision
Effective January 17, 2003, VA suspended NEW enrollment of veterans assigned to Priority Group 8e or 8g (VA's lowest priority group consisting of higher income veterans). These veterans are not eligible for enrollment at this time. Priority Group 8e or 8g assignment is based on the following:
Either the veteran's houshold income exceeds both the current year VA natonal income threshold and the geographic income threshold for the veteran's residence,
or
The veteran declined to provide his/her household financial information, and
The veteran does not have any special qualifying eligibilities such as a compensable VA service-connected disability.
Veterans enrolled in Priority Group 8a or 8c on or before January 16, 2003, remain enrolled and continue to be eligible for the full-range of VA health care benefits. Changes in VA's available resources may affect the number of priority groups VA can enroll in a given year. If that occurs, VA will publicize the enrollment changes and notify affected enrollees.
Impact
Enrollment of veterans into Priority Groups 1 through 7 in NOT impacted by this suspension and continues without restriction. The decision to suspend new enrollment of veterans in VA's lowest priority group helps to ensure that quality and timely care will be available to veterans with service-connected conditions, veterans with special authority based on military service, lower-income veterans, and those with special health care needs.
To view the VA National Means Test income threshold table, visit the website at
http://www.va.gov/healtheligibility/Library/pubs/VAIncomeThresholds/
To view the Geographic MeansTest income threshold table, visit the website at
http://www.va.gov/healtheligibility/Library/pubs/GMTIncomeThresholds/
To view a full listing of VA health care enrollment Priority Groups, visit the website at
http://www.va.gov/healtheligibility/Library/pubs/EPG/
For more information,
contact the Health Benefits Service Center at 1-877-222-VETS (8387).
