How Outreach and Enrollment Staff Can Connect Veterans to Coverage
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
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
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)
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
VHA Medical Centers (VAMC) Located in Virginia Hampton VAMC, Hampton 100 Emancipation Drive, Hampton, Virginia 23667 Phone: (757) 722-9961 Toll-Free: (866) 544-9961 Hunter Holmes McGuire VAMC, Richmond 1201 Broad Rock Boulevard, Richmond, Virginia 23249 Phone: (804) 675-5000 Toll-Free: (800) 784-8381 Salem VAMC, Salem 1970 Roanoke Boulevard, Salem, Virginia 24153 Phone: (540) 982-2463 Toll-Free: (888) 982-2463
Community Based Outpatient Clinics known as CBOCs
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
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 http://hbexplorer.vacloud.us/ Outreach and Enrollment staff can help direct Veterans to services for healthcare and benefits
Directing Veterans to Needed Services
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: http://www.va.gov/healthbenefits/apply/veterans.asp
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
Why Ask?. Myth: All Veterans look like this
Fact: Veterans have no stereotypical appearance Never Make Assumptions
Eligibility Determination Assess status Veteran? Enrolled in VA care? Link for assessment tool: http://hbexplorer.vacloud.us/
Need Help? Health Eligibility Center 877-222-VETS (8387) Or visit your local VA Medical Center or CBOC
How to Apply In person at any VA Medical Facility Online: www.va.gov/healthbenefits/enroll Mail: Health Eligibility Center Enrollment Eligibility Division 2957 Clairmont Road Suite 200 Atlanta, GA 30329-1647 application: www.va.gov/healthbenefits/enroll Call: 877-222-VETS (8387) M-F 8AM -8PM ET
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 >
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 www.va.gov/directory. Eligibility determined by service and means test
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
Service Connection Video
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
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
What if the Veteran wants to get care outside of the VA?
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
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 866-606-8198
Veteran s Choice Card https://www.hnfs.net/content/dam/hnfs/va/pccc/veteranschoice/choice_fact_sheet.pdf
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*
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 https://www.hnfs.net/content/hnfs/home/va/home/veterans-choice.html If the Veteran lost their Choice card and needs a new one Call Center Number 866-606-8198
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 Email Phone Hunter Holmes MacGuire VAMC Nora Vanderpool Nora.Vanderpool@va.gov 804-675-5387 Hampton VAMC Kevin Amick Kevin.Amick@va.gov 757-722-9961 ext. 3061 Salem VAMC Janet Zellis Janet.Zellis@va.gov 540-982-2463 ext. 2761
Veteran Crisis Line http://www.veteranscrisisline.net/default.aspx 800-273-8255 Chat and text options also
Need to find the Closest Resource for Veterans?
http://www.veteranscrisisline.net/gethelp/resourcelocator.aspx
Benefits and Cemetery Virginia Department of Veterans Services http://www.dvs.virginia.gov/ Find the one nearest to you: http://www.dvs.virginia.gov/dvs/locations/ Can help with getting them Service Connected Disability Family benefits, Cemetery, Employment, etc.
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 Email: melek.sanchez@dvs.virginia.gov Office: (804) 786-0595 Have a question about why benefits were denied?
One Last Thing Don t forget to thank Veterans for their service to our country.
Any Questions? Danielle M. Nugent, CHES, PCMH CCE, CPF Healthcare Transformation Specialist Virginia Community Healthcare Association 3831 Westerre Parkway Henrico, VA 23233-1330 Phone: (804) 237-7677 ext. 1248 dnugent@vacommunityhealth.org