Caregiver Stipend Program for Recent Veterans Creates Confusion for VA Health Providers, Beneficiaries

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WASHINGTON — While VA has quickly rolled out its new caregiver-assistance program for Iraq and Afghanistan veterans, speed may have come at the expense of transparency and consistency. Or, so said caregivers who report trouble understanding the limitations of the act, as well as disparities in how VA determines the size of the caregiver stipend.

VA providers, meanwhile, said their hands are sometimes tied by the strict eligibility provisions of the program, which excludes, among others, patients who are ill but not injured. In addition, providers say they are frustrated by their inability to provide similar support to caregivers of geriatric patients.  

Delays in Implementation

The Caregivers and Veterans Omnibus Health Services Act was signed into law in May 2010. It authorized VA to establish a wide range of new services to support certain caregivers of eligible OIF/OEF veterans. This included education and training, healthcare coverage for caregivers, respite care, mental health services and counseling, plus a monthly stipend for caregivers who curtailed their own careers or quit working entirely to care for their friend or family member.

The law required VA to create a host of new regulations, most notably ones determining eligibility of veterans, designating and approving caregivers and providing stipends.

When VA returned with an implementation plan — one that would roll out the new benefits during the summer of 2011 — Congress was not pleased. VA’s proposed rules for implementing the new benefits shut out many of the veterans that the law was designed to help, legislators said. While Congress had expected about 3,500 veteran families to be eligible under the act, VA’s regulations would allow only about 850 to qualify.

This resulted in a number of angry messages from legislators to VA officials, and in the inevitable questioning of VA officials on the Caregiver Act during Congressional hearings, regardless of the topic of the hearing. In March 2011, a bipartisan group of legislators from the Senate and House sent a letter to President Obama urging him to block VA’s plan to implement the new program until it was redesigned to fit with the law’s original intent.  

In response to this pressure, VA changed its eligibility requirements and expedited the implementation of caregiver benefits by publishing an Interim Final Rule (IFR) on May 5, 2011. The IFR allowed VA to accelerate the rule-making process and to immediately implement the program prior to the consideration of public comments and the issuing of a final rule.

As a result, caregivers began applying for benefits in May, with the first stipends being sent out last month. As of mid-July, 1,000 caregivers had applied for support, and 176 had received stipends totaling $430,000

Legislators remain concerned that the plan does not go far enough, and that there are inconsistencies in who determines the extent of the benefits for each caregiver, or if they are given at all.

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