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Va - Priority Groups Table


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http://www.va.gov/healthbenefits/resources/priority_groups.asp

Priority Groups Table

The number of veterans who can be enrolled in the health care program is determined by the amount of money Congress gives VA each year. Since funds are limited, VA set up Priority Groups to make sure that certain groups of veterans are able to be enrolled before others.

Once you apply for enrollment, your eligibility will be verified. Based on your specific eligibility status, you will be assigned a Priority Group. The Priority Groups range from 1-8 with 1 being the highest priority for enrollment. Some veterans may have to agree to pay copay to be placed in certain Priority Groups.

You may be eligible for more than one Enrollment Priority Group. In that case, VA will always place you in the highest Priority Group that you are eligible for. Under the Medical Benefits Package, the same services are generally available to all enrolled veterans.VA determines your eligibility for VA’s comprehensive medical benefits package through our patient enrollment system, which is based on Priority Groups from 1 through 8.

Priority Group 1

  • Veterans with VA Service-connected disabilities rated 50% or more.
  • Veterans assigned a total disability rating for compensation based on unemployability.


    Priority Group 2
    • Veterans with VA Service-connected disabilities rated 30% or 40%.


      Priority 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% or 20%.
      • Veterans awarded special eligibility classification under Title 38, U.S.C., § 1151, “benefits for individuals disabled by treatment or vocational rehabilitation.”


        Priority 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.


          Priority Group 5
          • Nonservice-connected Veterans and noncompensable Service-connected Veterans rated 0%, 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.

            Priority Group 6
            • Compensable 0% 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 January 9, 1962 and May 7, 1975.
            • Veterans who served in the Southwest Asia theater of operations from August 2, 1990, through November 11, 1998.
            • Veterans who served in a theater of combat operations after November 11, 1998, as follows:
              • Veterans discharged from active duty on or after January 28, 2003, for five years post discharge



                Priority Group 7
                • Veterans with incomes below the geographic means test (GMT) income thresholds and who agree to pay the applicable copayment.

                Priority 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 copays

                  Veterans eligibility for enrollment: Noncompensable 0% service-connected and:

                    [*]

                      [*]Subpriority a: Enrolled as of January 16, 2003, and who have remained 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% or less

                      Veterans eligible for enrollment: Nonservice-connected and

                        [*]

                          [*]Subpriority c: Enrolled as January 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% or less

                          Veterans not eligibility for enrollment: Veterans not meeting the criteria above:

                            [*]

                              [*]Subpriority e: Noncompensable 0% service-connected

                              [*]Subpriority f: Nonservice-connected

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Carlie I go to the Minneapolis VA and there is no such thing as Priority Groups anymore, I'm 60% and waited 4 months for back surgery, not because there's that many disabled vets up here that need surgery it's just first come first served, it's the same way at the Saint Cloud MN. VA... been that way for years.

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Carlie I go to the Minneapolis VA and there is no such thing as Priority Groups anymore, I'm 60% and waited 4 months for back surgery, not because there's that many disabled vets up here that need surgery it's just first come first served, it's the same way at the Saint Cloud MN. VA... been that way for years.

Sorry - but wrong - yes, there certainly are Priority Groups -

whether you see anything that relates to them or not is something completely different.

Also, I highly doubt that disabled vets in need of surgery are scheduled on a

first come - first served basis.

This is usually prioritized more by the severity of the condition, the availability of the surgeon/s

and scheduling in the ORs.

Minneapolis - isn't much different than other VAMC's.

Editing to add :

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

Special Access to Care

Service-Disabled Veterans: who are 50 percent or more disabled from service-connected conditions, unemployable due to service-connected conditions, or receiving care for a service-connected disability receive priority in scheduling of hospital or outpatient medical appointments.

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Priority groups dont have anything to do with actual medical care.

It is for benefit purposes only. Being in group one doesn't afford a veteran head of the line medical treatment. It Just ensures where a veteran stands on co pays and ect.

This is often confusing as I see vets all the time complain that they are in priority group 3 and are demanding to be seen first.

This really cracks me up as I sit there quietly. But you folks who know me, There comes a time when I am not so quiet.

Basser

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  • 8 months later...

For the last 4 months I have receive a letter froj the Department of Veterans Affiars, Health Eligibility Center in Georgia that says "Our records indicate that information used to establish your benefits of VA health care recently changed...." . Attached to the letter is a form for a ppeal the decision, the problem is that the form does not state why the decision was made or what caused a decision to be made. Additional the Uniques eligiblility factors and the percents have not change. My question is this a letter that is significant or is this just more VA paper work? I have always remained a Priority group 2 veteran.

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  • 1 year later...

Can the priority group status for a vet be changed as their disability changes ie: increase in disability and/or ssdi award? and how would one start in requesting the change?

Thanks

wes

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