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Relaxation of Priority Group 8 Enrollment Restrictions – 2/17/09
Public Law 110-329 provides VA additional funding to allow expanded enrollment opportunity for certain Priority 8 veterans who may have been previously denied enrollment in VA’s health care system because their income exceeded VA’s means tests thresholds. The proposed provision will allow veterans whose incomes do not exceed these thresholds by more than 10 percent to enroll in VA’s health care system. It has been determined that this relaxation will not negatively impact the timeliness or quality of care to enrollees. This provision is expected to take effect this June and will be applied retroactively to all enrollment applications received on or after January 1, 2009.
Two new sub-priorities have been established within enrollment priority group 8 (8b and 8d). Beginning on the effective date of the regulation, VA would enroll priority category 8 veterans whose income exceeds the current means test threshold (MTT) and geographic means test income thresholds (GMTT) by 10% or less. It is anticipated that this rule will take effect by June 30, 2009.
On the effective date of the regulation, a veteran who has applied for enrollment, who does not qualify for a higher priority group and whose income exceeds the MTT or GMTT by 10% or less will be placed in priority group 8b (if the veteran is 0% service-connected, non-compensable) or 8d (if the veteran is non service-connected) and enrolled in the VA health care system.
Prior to the effective date of the rule, a veteran who applies for enrollment, who does not qualify for a higher priority group and whose income exceeds the MTT or GMTT by 10% or less will continue to be placed in priority group 8e or 8g.
However, while VA is not advising veterans who may meet the new eligibility criteria to apply prior to effective date of the regulation, VA will inform veterans and Veterans Service Organizations of plans for the Health Eligibility Center (HEC) to re-determine the enrollment status of those veterans who applied after January 1, 2009 but were rejected for enrollment due to income. This approach reduces burdens to the sites (by not requiring veterans to apply for enrollment twice in the same year), provides for greater benefit to veterans, and uses consistent income information in the application process. For those veterans who apply on or after January 1, 2009 and are placed into a rejected priority group due to income, VA enrollment correspondence will indicate that VA will re-determine enrollment after the effective date of the new rule.
HEC is distributing scripts for use by frontline Medical Center staff to assist in communicating with veterans and to assist with processing enrollment applications. Additionally, the Health Revenue Center (HRC) Health Benefits Service Center is developing scripts for call agents to assist veterans with questions related to this enrollment change.
HEC is also developing a Means Test Calculator to assist the field in a Preliminary enrollment determinations based on the data entry.