Va Health Care Priority Groups

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VA Health Care Priority Groups

http://www.va.gov/opa/publications/benefits_book/benefits_chap01.asp

The following four categories of Veterans are not required to enroll, but are urged to do so to permit better planning of health resources:

1. Veterans with a service-connected disability of 50 percent or more.

2. Veterans seeking care for a disability the military determined was incurred or aggravated in the line of duty, but which VA has not yet rated, within 12 months of discharge.

3. Veterans seeking care for a service-connected disability only.

4. Veterans seeking registry examinations (Ionizing Radiation, Agent Orange, Gulf War/Operation Iraqi Freedom/Operation New Dawn and Depleted Uranium).

Priority Groups

During enrollment, each Veteran is assigned to a priority group. VA uses priority groups to balance demand for VA health care enrollment with resources. Changes in available resources may reduce the number of priority groups VA can enroll. If this occurs, VA will publicize the changes and notify affected enrollees.

A description of priority groups follows:

Group 1:

Veterans with service-connected disabilities rated 50 percent or more and/or Veterans determined by VA to be unemployable due to service-connected conditions.

Group 2:

Veterans with service-connected disabilities rated 30 or 40 percent.

Group 3:

• Veterans who are former POWs.

• Veterans awarded the Purple Heart Medal.

• Veterans awarded the Medal of Honor.

• Veterans whose discharge was for a disability incurred or aggravated in the line of duty.

• Veterans with VA service-connected disabilities rated 10 percent or 20 percent.

• Veterans awarded special eligibility classification under Title 38, U.S.C., § 1151, "benefits for individuals disabled by treatment or vocational rehabilitation."

Group 4:

• Veterans receiving increased compensation or pension based on their need for regular aid and attendance or by reason of being permanently housebound.

• Veterans determined by VA to be catastrophically disabled.

Group 5:

• Nonservice-connected Veterans and noncompensable service-connected Veterans rated 0 percent, whose annual income and/ or net worth are not greater than the VA financial thresholds. Veterans receiving VA Pension benefits.

• Veterans eligible for Medicaid benefits.

Group 6:

• Compensable 0 percent Service-connected Veterans.

• Veterans exposed to ionizing radiation during atmospheric testing or during the occupation of Hiroshima and Nagasaki.

• Project 112/SHAD participants.

• Veterans who served in the Republic of Vietnam between Jan. 9, 1962 and May 7, 1975.

• Veterans who served in the Southwest Asia theater of operations from Aug. 2, 1990, through Nov. 11, 1998.

• Veterans who served in a theater of combat operations after Nov.11, 1998, as follows:

• Veterans discharged from active duty on or after Jan. 28, 2003, for five years post discharge;

• Veterans who served on active duty at Camp Lejeune for not fewer than 30 days beginning Jan. 1, 1957 and ending Dec. 31, 1987.

Group 7:

• Veterans with incomes below the geographic means test income thresholds and who agree to pay the applicable copayment.

Group 8:

• Veterans with gross household incomes above the VA national income threshold and the geographically-adjusted income threshold for their resident location and who agrees to pay copayments. Veterans eligible for enrollment: Noncompensable 0-percent service-connected and:

• Subpriority a: Enrolled as of Jan. 16, 2003, and who have re-mained enrolled since that date and/ or placed in this subpriority due to changed eligibility status.

• Subpriority b: Enrolled on or after June 15, 2009 whose income exceeds the current VA National Income Thresholds or VA National Geographic Income Thresholds by 10 percent or less

• Veterans eligible for enrollment: Nonservice-connected and Subpriority c: Enrolled as of Jan. 16, 2003, and who remained enrolled since that date and/ or placed in this subpriority due to changed eligibility status

• Subpriority d: Enrolled on or after June 15, 2009 whose income exceeds the current VA National Income Thresholds or VA National Geographic Income Thresholds by 10 percent or less

• Veterans NOT eligible for enrollment: Veterans not meeting the criteria above: Subpriority e: Noncompensable 0 percent service-connected Subpriority f: Nonservice-connected