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Tuesday, November 10, 2015

States Can Give Back to Veterans by Expanding Medicaid

Andrea Callow

Associate Director of Medicaid Initiatives

Nygel Williams

Villers Fellow

On Veterans Day, we pay tribute to the servicemen and women who have sacrificed for our nation. But lawmakers in the 20 states that have refused to expand Medicaid are missing an important opportunity to give back to veterans, nearly 1 in 10 of whom lack health insurance. By expanding Medicaid, these states can help uninsured veterans and their families.

Medicaid expansion can provide health insurance to veterans not eligible for VA health care

Our country has made a commitment to care for our veterans by providing them with comprehensive health coverage through the Veterans Health Administration (VA). What many people don’t know is that not all veterans are eligible to receive health insurance through the VA. And even those who are eligible may not always be able to access care.

Estimates are that only 2/3 of veterans are eligible for VA services, and only 1/3 are actually enrolled in VA health coverage.

The reasons veterans may not be eligible for health coverage through the VA or may not be able to reliably obtain VA health care vary. To receive care through the VA, veterans must meet certain criteria in terms of time served, disability, and income [See text box below]. 

Many men and women who are eligible for some VA coverage are unaware they can receive care through the VA. Thousands more live outside the treatment area of a VA hospital, leaving them and their families without reliable access to care. 

More than 300,000 veterans who could benefit and their spouses live in states that have not expanded Medicaid

In states that expanded Medicaid coverage under the Affordable Care Act, many uninsured veterans and their families who aren’t able to get care through the VA may qualify for expanded Medicaid. This means they make less than $21,980 per year (equal to 138 percent of the federal poverty level for a family of two). 

But 342,000 uninsured veterans and their spouses who make less than $21, 980 per year live in states that have chosen not to expand Medicaid to cover more residents. Those veterans and their spouses don’t have an option for affordable health care. For example, these estimates show how many veterans and their spouses could benefit from expansion in three states:

  • Florida: 55,000 veterans and their spouses
  • North Carolina: 32,000 veterans and their spouses 
  • Texas: 67,000 veterans and their spouses

Complex criteria for eligibility prevent many veterans and their spouses from receiving VA coverage

To be eligible for VA coverage, a veteran must have served for two continuous years or the full period for which they were called to active duty. For example, many Reserve or National Guard veterans do not qualify for VA benefits. It has become common in recent years for Reserve and Guard members to be called up for active service and sent on assignment, just like members of the regular military. If they complete the full term of their active service period, these troops can earn some VA benefits.

For decades, however, many Reserve and Guard servicemen and women were called up for training purposes only. They served for years without earning enough active service time to qualify for benefits. These troops’ spouses would likewise be ineligible for health care benefits through CHAMPVA, the civilian benefits service for family members of veterans. 

The VA also divides veterans into eight "priority groups" based on service-related disability, other disability, and income. These priority groups determine who can enroll in VA coverage, and when and what their cost-sharing will be (cost-sharing refers to out-of-pocket costs like copayments).  

Furthermore, spouses of veterans must meet an even more stringent criteria for eligibility. As a result, many spouses of servicemen and women lack health insurance because their spouses served tours of active duty but were not killed or disabled due to military service. 

Comprehensive health care services are especially important for veterans. Many veterans suffer from unique, and sometimes serious or complicated, health issues as a result of their time serving our county. These health issues include musculoskeletal conditions, traumatic brain injuries, and post-traumatic stress disorder. 

Low-income veterans—those who would be most helped by expanding Medicaid coverage—can be sicker, are more likely to be homeless, and are more likely to have post-traumatic stresssubstance use, and mental health disorders than higher-income veterans. For these veterans, the access to health care they could gain through Medicaid not only improves their overall health, it is integral to helping them achieve financial stability upon return to civilian life. 

Medicaid expansion could help high-need patients currently using VA services

In addition to offering health care to uninsured vets, Medicaid can expand the services available to some of the neediest veterans in the nation. A recent study found that three-quarters of homeless veterans using VA services would be eligible for Medicaid if their state expanded. The study found eligible veterans could benefit from increased access to needed substance use and mental health services. By expanding Medicaid, states can reach both veterans who are unable to access the VA, and high-need users currently in the VA system.

To benefit uninsured veterans, lawmakers should expand Medicaid

All veterans should have access to quality, affordable health care. None should fall through the cracks. One of the best ways states can make sure that’s true for their resident veterans is to expand Medicaid. 

Unfortunately, 20 states are leaving their lowest-income veterans behind. If you live in one of those states, take the opportunity to tell your governor and state legislators how many uninsured veterans could benefit from expansion. Urge them to do something for the men and women in the state who have served our country and extend health coverage through Medicaid.