Changes to VA’s community care program raise concerns about vets’ health care access

Veterans Affairs leaders are phasing out the department’s office in charge of community care programs, a move that some advocates are decrying as unfairly limiting veterans’ medical options but officials insist is only about efficiency and not sweeping policy changes.

Last week, VA officials said they would begin a multi-month process of “designing a new integrated access and care coordination model to better deliver seamless care.”

Connected to that, lawmakers on Capitol Hill received letters from VA Secretary Denis McDonough announcing that the Office of Community Care would be decommissioned in coming months, with its responsibilities shifted to a yet-to-be-established Office for Integrated Veterans Care.

“Implementation of these changes allows the Veterans Health Administration to continue its modernization journey and transformation to operate as a high reliability, veteran-centric organization,” the letter stated.

The issue of community care — where veterans can see private-sector doctors paid for by department funds — has been a contentious one within VA for years.

Former President Donald Trump made expanding outside medical access a key point of his 2016 campaign and presidency, pushing for more “choice” for veterans in where they received their health care.

But Democratic lawmakers — including President Joe Biden — have cautioned that too much use of private-sector doctors for core VA medical responsibilities could drain finances from the VA health care system and lead to “privatization” of the department.

In a statement to Military Times, Donald Koenig, special advisor to VA’s acting Under Secretary for Health for Integrated Veteran Care, said the goal of the new changes is not to hamper or dismantle the community care program.

“Nothing we are doing will change any appointments scheduled now or in the future,” he said. “We’re working to simplify, coordinate better, and make scheduling faster for veterans, whether for a VA provider or a community care provider. Our goal is to deliver the right care at the right time, that best meets our veteran’s health needs.”

Officials at Concerned Veterans of America — longtime advocates of increased community care programs and critics of the VA health care system — see it differently.

They noted that VA also recently took down a web page devoted to explaining veterans’ options under the community care program, effectively limiting public information about how to enroll or schedule outside appointments.

“The administration does not like community care,” said Darin Selnick, senior advisor to the group and former Veterans Affairs advisor for the Trump White House. “If they are renaming and neutering offices and moving around access to the revenue, it feels like it is part of a campaign to get rid of it completely.”

Koenig said the Office of Community Care won’t be fully shut down until next spring, with a target now of March 2022.

About 3,600 employees will be transferred to the new integrated care office, while another 4,300 will be reassigned to the Veterans Health Administration’s finance office. No jobs will be terminated or physically relocated.

But Selnick said CVA has heard from numerous veterans and congressional offices about increased problems accessing the program and getting outside medical appointments. He said the decision to separate the financial and operational functions of the program could cause even more delays and confusion.

VA officials say that’s not true, noting that community care referrals were up about 12 percent last month compared to 2019 levels (September 2020 levels were down about 6 percent, but VA leaders say that’s because of reduced demand related to the coronavirus pandemic.)

Lawmakers received a briefing on the looming changes this week. House Veterans’ Affairs Committee ranking member Mike Bost, R-Ill., said he supports efforts to improve the community care program, but said he is leery of the moves so far.

“I am hearing more and more often from veterans who are not being given the choices they are entitled to under the law,” he told Military Times. “I am very concerned that this will divert much-needed focus from community care and make it that much easier for wait times to creep back up and veterans to suffer for it, just like they did in 2014.

“It’s on Secretary McDonough to make sure that doesn’t happen, and I will be keeping very close watch.”

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