How Outreach and Enrollment Staff Can Connect Veterans to Coverage

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1 How Outreach and Enrollment Staff Can Connect Veterans to Coverage

2 Virginia Community Healthcare Association Membership organization consisting of FQHCs and one RHC in Virginia Services include outreach and enrollment training, quality improvement, advocacy and public policy, recruitment, etc. Working in conjunction with the VA, the Governor's office and our members to help Veterans get access to care and benefits

3 Objectives Introduce the Veterans Administration Clarify the role of Outreach staff in aiding Veterans in getting benefits Discuss different programs available to Veterans Provide resources you can use when you meet with Veterans Connect outreach workers with their local Veterans Medical Center

4 About the Department of Veterans Affairs (VA) Robert A. McDonald Secretary of VA Federal government s second largest department after the Department of Defense (DoD) Three components: Veterans Benefits Administration (VBA) National Cemetery Administration (NCA) Veterans Health Administration (VHA)

5 What is the VHA? A Healthcare Program funded by Congress Largest Integrated Healthcare System in the U.S. Over 1,700 Care Sites 9 Million + Veterans Served Annually

6 VHA Medical Centers (VAMC) Located in Virginia Hampton VAMC, Hampton 100 Emancipation Drive, Hampton, Virginia Phone: (757) Toll-Free: (866) Hunter Holmes McGuire VAMC, Richmond 1201 Broad Rock Boulevard, Richmond, Virginia Phone: (804) Toll-Free: (800) Salem VAMC, Salem 1970 Roanoke Boulevard, Salem, Virginia Phone: (540) Toll-Free: (888)

7 Community Based Outpatient Clinics known as CBOCs

8 VA Care and the ACA Those covered under VA care meet the requirement for the healthcare law coverage standards If a Veteran is enrolled in VA care they are not eligible for tax credits or subsidies through the marketplace Marketplace can offer coverage to families of Veterans and to Veterans that don t qualify for VA healthcare Transferring out of the military counts as a loss of coverage for military families

9 O&E Staff Can Help 781,000Veterans in Virginia 260,000 Veterans enrolled in VA care Young Veterans who don t think they need coverage (mandate) Older Veterans that never signed up due to preconceived notions about VA care Not all Veterans are eligible for VA care Verify using health benefits explorer Outreach and Enrollment staff can help direct Veterans to services for healthcare and benefits

10 Directing Veterans to Needed Services

11 Veteran-Status Criteria Served on active status with the Army Navy Air Force Marines Coast Guard. Uniformed services: U.S. Public Health Service National Oceanic and Atmospheric Administration Commissioned Officer Corps Joined after 1980 and met the 24 month service requirement(national guard and reservists in active duty don t have 24 month requirement) National Guard or Reservists have to be called to active duty service and completed the full requirement of their time on active status. Source:

12 Starting Point ASK: Have you served in the U.S. Military? Army, Navy, Air Force, Marines, or Coast Guard? No Yes Are You Enrolled for VA Healthcare? Yes No Assess if eligible by calling VA or using the Health Benefits Explorer

13 Why Ask?. Myth: All Veterans look like this

14 Fact: Veterans have no stereotypical appearance Never Make Assumptions

15 Eligibility Determination Assess status Veteran? Enrolled in VA care? Link for assessment tool:

16 Need Help? Health Eligibility Center VETS (8387) Or visit your local VA Medical Center or CBOC

17 How to Apply In person at any VA Medical Facility Online: Mail: Health Eligibility Center Enrollment Eligibility Division 2957 Clairmont Road Suite 200 Atlanta, GA application: Call: VETS (8387) M-F 8AM -8PM ET

18 VA Healthcare If Eligible VA Care Covers: Primary Care Specialty Care Long-term care Inpatient care Mental Health and Substance Abuse Preventive Services Prescription Drugs (under VA formulary) More Next Slide >

19 Coverage includes No enrollment fee, premiums or deductibles May require co payment for health care or prescription drugs ( if non- service connected) Can be used with Medicaid, Medicare, Tri-Care or Private Insurance Care comes from a VA Medical Facility Veteran can find VA nearest to them through Eligibility determined by service and means test

20 Service Connected Care Service Connected Care: Service connection is a rating percentage (0-100%) which is related to an illness or injury incurred or aggravated due to active duty status. Veterans may receive monthly compensation for their SC conditions. All care related to SC conditions are free. The Veteran Benefits Administration determines and process all claims for SC conditions. Example: Veteran requiring physical therapy for injury obtained while serving over seas

21 Service Connection Video

22 Priority Groups Eligible Veterans ranked by priority group Rankings are 1 through 8 Priority group determines if there is a co-pay If Veteran qualifies for two groups they are always placed in the highest group The closer to priority group 1 the less likely you are to have a copay Example: A. Veteran with more than 50% service connected care may be priority group 1 and have no copays B. Veteran with non service connected care who makes slightly more than the VA s income limit and agrees to pay co-pays might fall into priority group 8

23 Co-Pays Changes based on priority level Examples: A. Veteran going to see his primary care provider through the VA may have to pay $15/ visit B. Prescription co-pays range from $8-$9 per 30 day supply (no co-pay for priority group 1) C. Veteran in adult day care may have to pay up to $15/day for services D. Veteran in priority group 1 has no co-pays

24 What if the Veteran wants to get care outside of the VA?

25 Veterans Choice Program Veterans Access, Choice and Accountability Act Initial 3-year program signed into law August 7, 2014 Currently being considered for extension Allows Veterans to access care outside of the VA Created with the intention of: Increasing access for Veterans Reducing wait times for Veterans

26 Veterans Choice Eligibility: Must live more than 40 miles from VA facility More than 30 day wait for care Experience geographical barrier (mountains, bodies of water, etc.) In the Eastern Shore the bridge/tolls count as a barrier Choice cards were sent in the mail to Veterans December 2014 Can get a card re-issued by contacting the call center

27 Veteran s Choice Card

28 Veteran receives Choice Card in the Mail Veteran calls CHC for an appointment Veteran shows up at CHC for care Veteran calls Number on the Card to verify Eligibility CHC directs Veteran to contact number on the card* Call center determines eligibility and schedule s appointment for Veteran * If Veteran does not request to receive care at a specific CHC, the call center will make the assignment. If the Veteran wants to be seen at your health center, the Vet will have to make that request when speaking with the call center about eligibility for the program. You will want to make sure the Vet has correct information so that your center can be requested. CHC directs Veteran to contact number on the card*

29 The CHOICE Call Center Best to Call If: Eligibility questions Determining if a Veteran is eligible Determining if your practice is eligible to participate or check out the website If the Veteran lost their Choice card and needs a new one Call Center Number

30 VAMC Resources Can answer questions about Veteran Eligibility Can help to figure out referrals, prescription meds etc. Great for the VAMC perspective Can connect you to other VA resources VAMC Choice Contact Phone Hunter Holmes MacGuire VAMC Nora Vanderpool Hampton VAMC Kevin Amick ext Salem VAMC Janet Zellis ext. 2761

31 Veteran Crisis Line Chat and text options also

32 Need to find the Closest Resource for Veterans?

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34 Benefits and Cemetery Virginia Department of Veterans Services Find the one nearest to you: Can help with getting them Service Connected Disability Family benefits, Cemetery, Employment, etc.

35 Benefits Issue/ Concern? Veteran having trouble getting their service connected disability? Veteran having an issue getting their paperwork approved? Contact: Melek Sanchez, Virginia Benefits Enhancement Program Coordinator Virginia Department of Veterans Services Office: (804) Have a question about why benefits were denied?

36 One Last Thing Don t forget to thank Veterans for their service to our country.

37 Any Questions? Danielle M. Nugent, CHES, PCMH CCE, CPF Healthcare Transformation Specialist Virginia Community Healthcare Association 3831 Westerre Parkway Henrico, VA Phone: (804) ext