WASHINGTON, DC — In a case of unintended consequences, as many as 90% of post 9/11 veterans currently enrolled in the VA’s Program of Comprehensive Assistance for Family Caregivers (PCAFC) were in danger of being discharged due to an ongoing wave of eligibility reforms.
In response, VA announced this spring that it was placing a moratorium on the ejection of current participants in the program. In June, the department took it a step further by suspending all annual reassessments of current PCAFC participants.
In 2010, Congress passed the Caregivers and Veterans Omnibus Health Services Act, which provided benefits to caregivers of post-9/11 veterans that included: a monthly stipend, health insurance, education and training, travel expenses, respite care, and mental health services and counseling. To be eligible for the program, the veteran involved must have incurred a serious injury or psychological trauma in the line of duty and need personal care services because of “an inability to perform one or more activities of daily living and/or need supervision or protection based on symptoms or residuals of neurological impairment or injury.”
The program was considered such a great success that, as part of the 2018 MISSION Act, Congress ordered VA to expand it to include veterans of all eras. In 2020, VA expanded the program to include veterans who served before 1975, and in fall 2022 is due to expand it to include all remaining veterans.
However, during phase one of the expansion in 2020, VA narrowed the eligibility criteria to veterans with a 70% or higher disability rating and placed a heavier emphasis on the language involving a need for assistance with “activities of daily living.” Prior to phase two of the expansion happening this fall, VA began an evaluation of all legacy participants to see if they met the adjusted guidelines.
Currently, there are 33,000 total veterans enrolled in the program. Of those, approximately 20,000 are legacy participants enrolled prior to the criteria change in 2020.
As VA began its evaluation, it discovered that as many as 90% of those 20,000 would not meet the new criteria and were in danger of losing their caregiver benefits. When news of this was made public, it sparked protests among program participants, legislators and veterans’ advocates.
On March 22, VA leaders announced that they would continue the reassessments of legacy participants and legacy applicants, but would not discharge or decrease any ongoing support. The announcement came one day prior to a Senate VA Committee hearing on the subject.
“We want to have a complete data set on our veterans in different cohorts,” explained Assistant Under Secretary for Health Beth Taylor on the continuing reassessment. “We also need to be clear about the actions we will not be taking as a result of the assessments. We want to ensure that we’re very clear about our communications with those caregivers. We know, historically, that we haven’t done the best job.”
As VA conducted these reassessments, the department learned more about the day-to-day lives of the veterans and caregivers in the program and discovered that caregiver support does not look the same for all veterans.
Different Needs
“Different eras of veterans have different needs,” Taylor explained. “We’ve also found that some veterans, while they need support services, might need them intermittently and not as narrowly as originally described in the regulation. For example, there may be a veteran who is receiving radiology or oncologic chemotherapy procedures and there are periods of time when they need a caregiver … or there may be a veteran who has had a very significant surgery and for a period of time they may need caregiver support. Those are two examples that give us an opportunity to reflect what we have written in our regulations and what clarifications or minor shifts we may be able to make to capture the men and women who need [periodic] care.”
In a letter to VA Secretary Denis McDonough in April, Sens. Jon Tester (D-MT) and Jerry Moran (R-KA), asked VA to consider that wide range of needs when determining eligibility, especially when it concerns the “activities of daily living” language in the criteria.
“The law is clear that the personal care services requirement can be met by a need for assistance with an activity of daily living (ADL) or a need for supervision, protection or instruction,” they explained. “However, we continue to hear from caregivers that assessments unfairly place heavy emphasis on the need for assistance with an ADL … to the detriment of caregivers of veterans who may only require assistance related to supervision, protection, or instruction.”
This runs counter to congressional intent, they said, which seeks to cast a wider net in bringing veterans and caregivers into the program.
Responding to the pushback from legislators, veterans, and their caregivers, VA announced in June that it was suspending the annual caregiver reassessments, though the overall review of PCAFC will continue.
VA will also conduct targeted reassessments, such as when a caregiver requests a higher stipend, or there is evidence of an increased need for personal care services. However, VA promised that the department would not discharge or reduce stipends based on a reassessment.
