GAO: Applications for VHA Healthcare Benefits Frequently Mishandled

By Sandra Basu

Wilmington, DE, VAMC and Philadelphia and Wilmington Veterans Benefits Administration office jointly held a Benefits Claims Workshop and Town Hall meeting last year to help work through obstacles or explain benefits of which they might have been previously unaware. VA photo.

WASHINGTON VHA does not have the right protocols in place to ensure applications for enrollment are processed in a timely manner or that enrollment determinations are accurate, according to a new report.

“Timely and accurate processing of veterans’ enrollment applications is critical to ensuring that eligible veterans obtain needed health care,” the Government Accountability Office (GAO) explained. “Without efficient and effective enrollment processes, veterans may be delayed in obtaining needed services or incorrectly denied benefits.”

The oversight group examined to what extent VHA has implemented better processes for enrolling veterans for healthcare benefits.

“We and others have expressed concerns about VA’s inability to effectively provide and oversee timely access to health care, which, in some cases, reportedly has resulted in harm to veterans,” the report stated.

Veterans seeking to enroll for healthcare benefits must submit an application to either VA’s Health Eligibility Center (HEC) or a VAMC. Applications are required to be processed within five days of receipt.

The problem, GAO noted, is that VHA enrollment staff, both from HEC and VAMCs, “frequently did not process enrollment applications in accordance with VHA’s timeliness standards and made incorrect enrollment determinations.”

GAO reviewed six VAMCs and found that, as of March and April 2017, VAMC enrollment staff had not resolved 31 of the 56 pending applications included in its random, nongeneralizable sample of pending applications.

            “Specifically we found that for 22 (71%) of the 31 unresolved applications, there was no evidence that VAMC enrollment staff had attempted to contact the veterans to obtain missing military service or financial information, and that 18 of these 22 applications had been in a pending status for three months or longer at the time of our review,” according to the report. “VAMC officials told us they were not aware that some of the unresolved were in a pending status prior to our review.”

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