Backlog Cleared, Problems Remain: CHAMPVA in the Hot Seat

Lawmakers examine what still is not working even after the VA cleared the application backlog.

December 11, 2025

⚡NIMITZ NEWS FLASH⚡

“Putting Families First: Strengthening CHAMPVA for Survivors and Dependents”

House Veterans Affairs Health Subcommittee Hearing

December 10, 2025 (recording here)

HEARING INFORMATION

Witnesses & Written Testimony (linked):

  • Dr. Maria Llorente, M.D.: Acting Assistant Under Secretary for Health, Office of Integrated Veteran Care, Department of Veterans Affairs

  • Mr. David Fennell: Director, Veteran and Family Member Programs, Integrated External Networks, Office of Integrated Veteran Care, Department of Veterans Affairs

  • Mrs. Caira Benson: Veteran Support & Strategic Initiatives Specialist, Code of Support Foundation

  • Mr. James Zenner: National Policy Director, National Association of County Veteran Service Officers

Keywords mentioned:

  • CHAMPVA, veteran healthcare, mental health, TRICARE, caregiver benefits, survivors, electronic claims, provider education, healthcare access, ACA premium tax credits, specialty care, customer service

IN THEIR WORDS

“If it walks like a duck and swims like a duck and quacks like a duck, it's probably a duck.”

Ranking Member Brownley, arguing that CHAMPVA functions like health insurance and should be treated and managed as such.

“Being a provider and a veteran, it seems to me that forcing providers to accept champ VA… would that be considered indentured servitude?”

Chairwoman Miller-Meeks

Witnesses spoke on CHAMPVA access and accountability.

OPENING STATEMENTS

  • Chair Mariannette Miller-Meeks stressed that CHAMPVA is an earned benefit that helps families of veterans with serious service-connected disabilities or deaths access essential health services. She praised the VA and Secretary Collins for eliminating the application backlog, modernizing online applications and electronic claims, and developing a provider directory. She noted ongoing problems, including slow paper-claim processing, poor transparency on claim and application status, and fragile paper “cards” that confuse providers. She said the subcommittee would continue oversight so CHAMPVA processes all claims faster and works more reliably for caregivers, spouses, and children.

  • Ranking Member Julia Brownley criticized the VA’s Office of Integrated Veteran Care for not briefing committee staff for a year despite overseeing $40 billion in community-care programs, including CHAMPVA. She argued that CHAMPVA still lacked basic insurance-like infrastructure, such as robust online self-service tools, a formal provider network or directory, and clear information on allowable payment rates. She defended her bill to let dependents stay on CHAMPVA until age twenty-six and rejected the VA’s claim that it is merely a medical benefit, noting CHAMPVA operates like insurance. She urged the VA to treat CHAMPVA as an insurance plan and fix known gaps instead of leaving families to navigate a complex system alone.

  • Dr. Maria Llorente testified that CHAMPVA provides healthcare coverage to over one million eligible spouses, surviving spouses, children, and some caregivers of veterans who are permanently and totally disabled or who died from service-connected conditions. She said that under Secretary Collins, the VA used overtime, process redesign, and automation to eliminate a large application backlog and sharply reduce appeals, so most claims were now processed electronically within days. She explained that the VA is modernizing CHAMPVA with more automated application systems and digital tools to reduce bureaucracy and improve transparency. She acknowledged that beneficiaries still struggle to find participating providers and said the VA is working to improve provider information and communication while continuing collaboration with Congress.

  • Mrs. Caira Benson said that although CHAMPVA promised her family a safety net after her husband’s severe service-connected brain injuries, using the program had been a nightmare. She described signing a $110,000 promissory note to secure hospitalization, a provider waiting twenty-seven months for payment, and paying out of pocket for her children’s mental health care. She said many providers avoid CHAMPVA because fee schedules are opaque, claims rules are confusing, and appeals are slow and code-driven. She praised the VA for clearing the application backlog and speeding electronic claims but urged statutory reforms, clearer regulations, mandatory electronic claims, and third-party review in appeals to prevent dangerous coverage gaps.

  • Mr. James Zenner thanked CHAMPVA staff for dramatically reducing application backlogs and noted that some applications were now processed in as few as four days, improving timely access to care. He explained that accredited county officers still must print, fax, or mail CHAMPVA applications, which prevents confirmation, tracking, and timely updates for families. He urged the VA to modernize the workflow with electronic submission, expand authority so officers could communicate directly with CHAMPVA staff, and educate providers who often misunderstood the program and its billing. He also recommended redesigning CHAMPVA ID cards and fixing coverage gaps for students turning eighteen through provisional coverage, automated school verification, and online certification tools.

SUMMARY OF KEY POINTS

  • Ranking Member Brownley asked why families still faced call center waits of over two hours to learn the status of CHAMPVA applications and school certifications, and whether those callers were prioritized for resolution. Dr. Llorente replied that waits could range from 5–10 minutes to several hours, admitted this was unacceptable, and said the VA was standardizing workflows, adding contractor capacity, and building online status verification for 2026, while using a callback feature to return calls.

  • Ranking Member Brownley then asked how the VA could draw more providers into the program. Mrs. Benson answered that CHAMPVA needed basic provider education on enrollment and billing systems and clearer, predictable payment information built on existing CMS and community care contracting backbones.

  • Rep. Kimberlyn King-Hinds praised the VA and Secretary Collins for reducing claim backlogs and moving toward a CHAMPVA provider directory, but stressed that families in the territories still faced severe access barriers.

  • Rep. King-Hinds asked how the VA could assure Congress the program functioned equitably when it did not track utilization, wait times, or outcomes in places like CNMI and Guam, and why utilization there was so low. Dr. Llorente responded that the VA currently tracked only claims volume by area, not wait times or outcomes, but agreed that data were lacking. She said a provider directory would be a first step toward assessing provider adequacy and targeting outreach, including to pediatricians in underserved territories.

  • Rep. Sheila Cherfilus-McCormick emphasized toxic exposures at bases like Red Hill and Camp Lejeune and asked whether the VA had considered expanding CHAMPVA to cover families harmed by such toxins and whether other agencies should help. Dr. Llorente replied that CHAMPVA eligibility was set in statute and that the VA instead operated several separate, exposure-specific family programs, such as for Camp Lejeune and Vietnam-related conditions, but was willing to work with Congress on additional categories.

  • Rep. Cherfilus-McCormick then highlighted Mrs. Benson’s $110,000 promissory note experience and asked how common such down payments were and whether the VA should track such outliers. Dr. Llorente said she had never seen a case like that, wanted details, and supported tracking similar situations to identify gaps.

  • Rep. Maxine Dexter underscored Oregon families’ reliance on CHAMPVA and asked whether the VA could require Community Care Network providers to accept CHAMPVA so beneficiaries could use a single provider directory. Dr. Llorente said she did not know the statutory or regulatory barriers and agreed to respond later, then confirmed that the CHAMPVA application backlog had peaked around May 2025.

  • Rep. Dexter asked how many applications were approved versus denied and how the VA handled a special queue for applicants with other health insurance. Dr. Llorente replied that about 80 percent of FY 2025 applications were approved, and Mr. Fennell added that an OHI backlog once around 300,000 had been largely cleared through automation, with roughly 20,000 cases remaining.

  • Rep. Herb Conaway warned that expiring enhanced ACA tax credits and soaring premiums could push many families toward CHAMPVA and asked whether the VA anticipated an enrollment surge and was planning for it. Dr. Llorente answered that she did not know how many eligible spouses or dependents currently used ACA coverage and said the VA’s planning focused instead on tracking recent growth in CHAMPVA enrollment, which had risen above 20 percent annually after the PACT Act.

  • Rep. Conaway then pressed on whether the VA knew how many CHAMPVA enrollees also had ACA insurance and on provider participation concerns. Dr. Llorente and Mr. Fennell said they did not have ACA overlap numbers and explained that CHAMPVA generally paid TRICARE-like rates as a secondary payer.

  • Chair Miller-Meeks clarified that only the enhanced ACA premium tax credits were expiring and questioned whether forcing community providers to accept CHAMPVA would amount to unconstitutional “indentured servitude,” asking Dr. Llorente to respond in writing.

  • Chair Miller-Meeks also asked whether the VA was using artificial or augmented intelligence to improve applications, claims, and status updates. Mr. Fennell replied that the VA had begun with automated business rules, was starting to deploy AI on newer platforms. Mrs. Benson confirmed that a contracted network and provider directory would significantly help families and caregivers.

  • Rep. Jen Kiggans underscored CHAMPVA’s importance to Hampton Roads caregivers and asked Mrs. Benson about her experience finding providers who accept the program. Mrs. Benson replied that she had called twenty-six hospitals before finding one that would take CHAMPVA for her daughter’s hospitalization and that she still paid out of pocket for most teen mental health and routine care because almost no local providers accepted it.

  • Rep. Kiggans then asked about common barriers, and Mr. Zenner cited provider confusion, limited education, and problems with the CHAMPVA ID card.

  • Rep. Kiggans asked how dependents learn about CHAMPVA and how the VA was improving customer service, and Dr. Llorente highlighted rating packets, direct outreach, added contractors, new telephony, and standardized workflows.

SPECIAL TOPICS

🖤 Mental health & suicide:

  • Mrs. Benson said her family still pays out of pocket for their children’s mental health providers because they have been unable to find pediatric mental health clinicians who accept CHAMPVA.

  • She added that at Code of Support, one of the most frequent requests from families is for mental health supports for dependents, and that multiple large regional/national providers take TRICARE but refuse CHAMPVA because the VA is “too difficult to work with.”

  • Mental health access problems were framed as a core weakness of CHAMPVA for kids.

👨‍💻 IT issues:

  • Multiple members and witnesses raised IT and systems issues around CHAMPVA.

  • Dr. Llorente and Mr. Fennell described efforts to modernize application and claims processing with automation, business rules, and emerging AI capabilities.

  • They discussed building online status verification so beneficiaries can check claim and application status without calling, and upgrading telephony to add more self-service options.

  • NACVSO’s Mr. Zenner highlighted the lack of electronic submission for CHAMPVA applications and called for a digital workflow similar to VBA’s National Work Queue so accredited officers can submit and track cases online.

📋 Government contracting:

  • Government contracting appeared indirectly in references to existing VA Community Care Network (CCN) contracts and TRICARE-like payment methodologies.

  • Mrs. Benson questioned why CHAMPVA could not better leverage existing CCN contracts and Medicare/CMS-based structures that already exist, implying underuse of current contractual infrastructure.

  • Mr. Zenner urged clearer billing rules and provider education to fit into existing electronic billing and insurance-like processes.

  • There was no detailed discussion of procurement, solicitations, or acquisition policy in the hearing.

 🧠 Traumatic brain injury (TBI):

  • Mrs. Benson stated that her husband deployed twice to Iraq as a combat engineer and suffered multiple traumatic brain injuries, compounded by toxic encephalopathy likely due to chemical exposure.

  • She testified as a caregiver for a severely injured veteran whose service-connected TBIs led to her family’s CHAMPVA eligibility.

  • Her story framed the stakes of CHAMPVA failures: even families of veterans with profound TBIs still face enormous administrative burdens, promissory notes, collections, and difficulty accessing needed specialty and mental health care.

⭐ Surviving spouses:

  • Dr. Llorente’s opening testimony described CHAMPVA eligibility as including spouses, surviving spouses, and children of veterans who are permanently and totally disabled due to service-connected disability, who died as a result of such conditions, or who died while rated permanently and totally disabled.

  • Dr. Llorente also noted coverage for certain survivors of members who died in the line of duty and for some primary family caregivers under the caregiver program.

  • Ranking Member Brownley’s questions connected this structure to her broader argument that CHAMPVA functions like an insurance plan that must be modernized for these survivors and dependents.

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