In honor of National Caregivers Month this November, the VA Palo Alto, CA, Health Care System, held events for friends and family who provide care to ill, injured or disabled veterans. VA photo WASHINGTON — Veterans from earlier eras should have expanded benefits related to family caregiver, but only if they are severely injured, VA officials have told Congress.

The agency said it supports expanding benefits to caregivers of pre-9/11 veterans under the condition that eligibility for the program is restricted to the most severely injured, said VA Secretary David Shulkin, MD, who added, “Regardless of age, regardless of when they served, this is an important program, but we have to do it in a way that is very thoughtful.”

The Comprehensive Assistance for Family Caregivers Program was created in 2010 as part of the Caregivers and Veterans Omnibus Health Services Act. While the overall law currently provides benefits to caregivers of all eras, the Family Caregivers Program portion of the law offers extended support and tiered stipends only to veterans serving after the 9/11 terrorist attacks and their family caregivers.

Noting that caregivers of pre-9/11 veterans are “unbelievably burdened,” Shulkin explained, “Last year VA spent about $500 million on the post-9/11 caregiver program. By expanding it to the pre-9/11 veterans, I think we can have a much bigger impact. We can do this in a cost-effective way and help those by focusing on those who need the benefit the most.”

Those comments came at a hearing held on the VA’s caregiver support program. The expansion of the caregiver program has been a source of debate in recent years as advocacy groups have wanted the benefit extended to caregivers of veterans of all eras.

The Senate version of a Choice reform bill pending in Congress includes a provision that would expand comprehensive care to veterans of all eras. Lawmakers pointed out that the provision was not supported by the White House without addressing related fiscal issues associated with its expansion.

The House version of the bill does not include this provision. House Committee on Veterans’ Affairs Chairman Rep. Phil Roe (R-TN) said during the hearing that he feels “strongly” that any legislation “to improve and expand the Family Caregiver Program should be developed, proceed through regular order and passed on its own merits.”

While Roe said he supports the program’s expansion, he believes that, before this is done, “we must ensure that the program is working as intended.”

“No veteran and no caregiver from any generation is well-served by having access in name only to a program that has the deficits this one does and is as ill-prepared as this one is to accept a sudden influx of new beneficiaries with complex, widely different caregiving needs from those veterans the program is currently serving,” Roe pointed out.

Changing Criteria

The current criteria for the Family Caregiver Program is that the post-9/11 veteran must need help with one activity of daily living. The VA is asking Congress to allow the agency to change the clinical criteria of the program so that only veterans who need help with at least three activities of daily living are eligible, as well as those with cognitive dysfunction. Shulkin emphasized, however, that he is not in favor of revoking the benefit for those who already use the program.

“If we were to simply expand it and use the exact same criteria that we do today for determining post-9/11 caregivers, we think that in 10 years we would have about 188,000 pre-9/11 caregivers. Today, we have 26,000,” he said about the program.

On the other hand, Shulkin explained that, if VA used a criteria “that would be a little bit more discriminatory” and limit eligibility to those who are the most severely ill or injured veterans, then the number would be an estimated 40,000 additional caregivers in the pre-9/11 group.

With the change in criteria, VA officials suggested that about $2.5 billion in costs could be avoided by 2030.

Meanwhile, committee Ranking Member Rep. Julia Brownley (D-CA) said she wanted to know what the timeline is in “rectifying” the “inequity” for the pre-9/11 group.

Shulkin said that this is up to Congress and that the “Senate has this included in their version” of the Choice bill, adding that the House has an opportunity to “have a discussion about that.”

“This is really your decision. The Senate and the House have to come to agreement on this,” he said.

Rep. Beto O’Rourke (D-TX) said he worried that, by narrowing the eligibility criteria, those with severe mental health issues who might be susceptible to suicide might be excluded.

“We are very sensitive to that,” Shulkin responded, noting that the VA’s proposal includes those with cognitive dysfunction.

Also weighing in were advocacy groups who voiced their support for expansion.

Disabled American Veterans Deputy National Legislative Director Adrian Atizado said, “there is no issue more important today than finally correcting the gross unfairness and inequity that discriminates against veterans ill and injured prior to Sept. 11, 2001, as well as their family caregivers.”

Paralyzed Veterans of America Associate Legislative Director Sarah Dean said that it “is unconscionable to tell those injured that only some of you will be helped.”