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“Delivering for Veterans and Caregivers: Year One of the Dole Act”

House Veterans Affairs Committee, Oversight and Investigations Subcommittee Hearing

March 4, 2026 (recording here)

HEARING INFORMATION

Witnesses & Written Testimony (linked):

• Dr. Thomas O'Toole: Acting Assistant Under Secretary for Health for Clinical Services, Veterans Health Administration, U.S. Department of Veterans Affairs

• Dr. Mark Koeniger: Acting Assistant Under Secretary for Health for Patient Care Services, Veterans Health Administration, U.S. Department of Veterans Affairs

• Mr. Kenneth Smith: Executive Director of Education Service, Veterans Benefit Administration, U.S. Department of Veterans Affairs

• Ms. Sharon Silas: Director, Health Care, U.S. Government Accountability Office

TOP-LINES TO SHOW YOU ARE IN THE KNOW

1. The VA reported that 25 of the 72 provisions in the Elizabeth Dole Act have been implemented. Work continues on the remaining sections, though several are already behind schedule or at risk of missing deadlines.

2. Lawmakers from both parties pressed VA officials on delays in rolling out key programs, including caregiver support, housing assistance, and workforce initiatives intended to improve veterans’ access to care and benefits.

3. Members raised concerns that staffing shortages and workforce reductions at VA facilities could worsen appointment delays, even as the department faces broader health care workforce challenges nationwide.

4. VA officials highlighted progress on several initiatives, including expanded community-based care services, suicide prevention reporting improvements, and education and technology training programs for veterans.

5. Members also underscored the need for clear timelines, accountability, and stronger outreach so veterans and their families are aware of the new benefits created under the Dole Act.

PARTY LINE PERSPECTIVES

OPENING STATEMENTS FROM THE SUBCOMMITTEE

• Chairwoman Jen Kiggans opened the hearing to examine the implementation of the Senator Elizabeth Dole 21st Century Veterans Health Care and Benefits Improvement Act and Congress’s responsibility to ensure the law was fully carried out. She explained that the bipartisan legislation aimed to modernize VA health care delivery, expand education and employment opportunities, strengthen caregiver support, address rural health disparities, and reduce veteran homelessness. She expressed concern that several provisions were behind schedule or nearing sunset without full implementation. Chairwoman Kiggans stressed that the VA must execute the law with urgency, transparency, and accountability so that veterans, caregivers, and families would experience the intended benefits.

• Ranking Member Delia Ramirez argued that the VA had made insufficient progress implementing the Dole Act and criticized department leadership for delays and workforce reductions. She said that key provisions addressing veteran homelessness, staffing models, and caregiver support had not been implemented despite being authorized by Congress more than a year earlier. She contended that cuts to thousands of VA positions, including medical professionals, had been made without required staffing models and could undermine care for veterans. Ranking Member Ramirez underlined the need for oversight and accountability to ensure veterans received the resources and services promised under the law.

SUMMARY OF KEY POINTS

• Dr. Thomas O'Toole testified that the VA had made significant progress implementing the Dole Act, noting that 25 of the 72 sections had been fully implemented while work continued on the remainder. He explained that oversight of the law’s implementation had been moved to the Office of the Secretary to ensure senior leadership involvement and coordination. Dr. O'Toole outlined several accomplishments, including expanded access to community care, increased support for non-institutional long-term care, expanded funding for homeless veteran programs, improvements to burial benefits, and progress on education and technology training initiatives. He acknowledged challenges in implementing certain provisions but expressed the VA’s commitment to working with Congress to deliver the law’s intended benefits.

• Ms. Sharon Silas reported that the Government Accountability Office (GAO) had reviewed several areas addressed by the Dole Act, including the Veterans Community Care Program and the Caregiver Support Program. She explained that the Community Care Program had grown significantly and that administrative processes remained complex and labor-intensive, prompting GAO to recommend improvements to staffing assessments and appointment scheduling oversight. Ms. Silas also described ongoing GAO work examining mental health support for caregivers, mentioning both available services and barriers such as difficulty accessing in-person support. She concluded that implementing GAO’s recommendations and the Dole Act’s requirements would help the VA improve care access and better support veterans and their caregivers.

• Chairwoman Kiggans asked how the VA had conducted outreach to inform veterans, families, and community partners about new education benefits and resources created under the Dole Act. Mr. Kenneth Smith responded that the VA primarily conducted outreach through its website, direct email campaigns to students, and partnerships with veterans service organizations (VSOs) that help disseminate information. Chairwoman Kiggans noted that many veterans may not regularly visit the VA website and suggested that the VA explore additional outreach methods, including communication in waiting rooms and outreach to civilian health providers who care for veterans.

• The Chairwoman questioned why the VA had not issued grants under the COPE Act caregiver mental health grant program despite Congress appropriating funding for it. Dr. Mark Koeniger responded that the VA had implemented mental health support for caregivers through the Virtual Caregiver Support Program, which had recorded nearly 29,000 encounters involving more than 4,300 unique caregivers. He explained that most of those services were delivered virtually, though caregivers could also receive in-person support.

• Chairwoman Kiggans then asked about the implementation of Section 142 of the Dole Act, which allows waivers to raise the pay cap for highly skilled physicians to help recruit and retain specialists. Dr. O'Toole acknowledged the importance of the authority but stated that the VA was still developing criteria for awarding the waivers because the issue affected many specialties and could have broader workforce implications. He said the VA expected to establish criteria within one to two months and hoped to begin issuing waivers shortly thereafter.

• Ranking Member Ramirez questioned how many physician pay waivers the VA had requested under Section 142 of the Dole Act. She mentioned that data provided to her staff indicated that no waivers had been requested or approved despite the authority being available. She criticized VA leadership for claiming it lacked authority to raise physician pay while failing to use the authority already granted by Congress.

• Ranking Member Ramirez also asked why GAO had recommended that the VA conduct a staffing assessment for the Community Care Program and how that recommendation related to staffing model requirements in the Dole Act. Ms. Silas explained that workforce planning is critical for agencies to align staffing resources with program needs and ensure timely scheduling of care. She claimed that GAO had consistently heard from VA facilities that staffing shortages hinder the timely processing of referrals and appointment scheduling, making comprehensive staffing models and performance metrics essential for effective care delivery.

• Rep. Amata Coleman Radewagen asked what the greatest barrier had been to implementing Section 302 of the Dole Act. Mr. Smith responded that the VA was currently working to publish a rule necessary to establish the grant program that would support outreach activities. He added that once implemented, the program would allow the VA to provide grants to state and tribal organizations to help conduct culturally responsive outreach to veterans.

• Rep. Radewagen inquired about GAO’s main concerns regarding the implementation of the Dole Act and whether the VA would complete the law within the required timeframe. Ms. Silas replied that many GAO reviews were still pending because they depended on the VA completing required reports or implementation steps. She said GAO could not yet determine whether the VA would meet all deadlines, but noted that several oversight reviews were ongoing.

• Rep. Tim Kennedy criticized reported workforce reductions at the VA and described cuts to health care positions in the Buffalo VA system, arguing that staffing shortages could delay care and harm veterans. He asked who would take responsibility if veterans were harmed due to reduced resources. Dr. O'Toole acknowledged the seriousness of staffing challenges and that workforce shortages affected the entire U.S. health care system. He explained that many eliminated positions had been long-vacant roles and underscored that clinicians directly providing patient care had not been targeted through the workforce reduction process, though attrition and broader workforce shortages remained ongoing challenges.

• Rep. Keith Self asked whether the implementation challenges surrounding the Dole Act involved presidential impoundment of funds. Dr. O'Toole answered that he was not aware of any impoundment related to the law.

• Rep. Self then questioned Dr. O'Toole about his earlier reference to a lack of funding and the VA’s use of funds from multiple accounts to implement provisions. Dr. O'Toole explained that some provisions did not include dedicated appropriations and that the VA had attempted to implement them using available resources from other accounts.

• Rep. Self raised concerns about whether changes to reimbursement rates for home health aide and homemaker services could reduce veterans’ access to home health care, particularly citing potential reductions in rural Texas. Dr. O'Toole responded that he could not speak specifically to the situation in Texas but emphasized that the VA had expanded home and community-based services and that hundreds of thousands of veterans had benefited from those programs.

• Rep. Self also pressed Dr. O'Toole on accountability for delayed provisions of the Dole Act, asking who would be responsible for implementation. Dr. O'Toole replied that senior leadership across the VA, including himself and the Office of Strategic Initiatives, was responsible for overseeing implementation.

• Rep. Juan Ciscomani asked how the Veterans Health Administration prioritized implementing different reforms under the Dole Act to address the most immediate needs of veterans. Dr. Koeniger said that the VA prioritized programs addressing significant medical needs and highlighted expanded community-based and caregiver support services as part of those efforts. Rep. Ciscomani pressed for more detail on how veterans with the greatest needs were identified and prioritized, and Dr. Koeniger agreed to follow up with additional details about the specific process.

• Rep. Ciscomani inquired about the measurable improvements veterans should expect in access to care as the Dole Act was implemented, noting that many veterans reported delays in obtaining appointments. Dr. O'Toole stated that the law represented one of the most significant pieces of legislation affecting the VA in decades and required simultaneous implementation of numerous provisions across the agency. He acknowledged that some delays had occurred due to leadership transitions and the government shutdown, but expressed confidence that several provisions would soon be published in the Federal Register and implemented.

• Rep. Ciscomani raised broader concerns about delays in implementing the legislation and underlined that veterans were waiting for results more than a year after passage. Dr. Koeniger added that improving access to care was a complex process involving many factors and noted that the VA had established the Access, Choice, and Excellence initiative to measure and improve access to care across the system.

• Chairwoman Kiggans asked for an update on the pilot program under Section 127 of the Dole Act, designed to strengthen assisted living services for aging veterans. Dr. Koeniger reported that the VA was developing purchasing authority and fee schedule options necessary to launch the pilot programs. He mentioned that the VA was still working through the details needed to implement the pilots, but confirmed that progress was being made.

• The Chairwoman questioned how the VA planned to address conflicts between the “best medical interest” standard for care and transportation benefits that disabled veterans rely on to reach appointments. Dr. O'Toole acknowledged that transportation barriers were a significant issue and stated that the VA was encountering challenges implementing the relevant provisions. He said the department hoped to work with the Committee to address those challenges and improve transportation support for veterans.

• Ranking Member Ramirez asked whether staffing models required by the Dole Act had been used to determine the removal of nursing positions at VA medical centers in Chicago. Dr. O'Toole responded that the positions referenced were vacant roles that had not been filled for some time, rather than active staff positions. Ranking Member Ramirez disputed that characterization, citing data she said showed that many of the positions had recently been filled, and requested additional clarification for the record.

• The Ranking Member criticized the pace of Dole Act implementation, stating that only 25 of the 72 sections had been completed more than a year after enactment. She argued that delays had prevented homeless veterans and service providers from accessing resources authorized by Congress. She pledged continued oversight to ensure the VA fully implemented the law and delivered the intended benefits to veterans.

• Chairwoman Kiggans reiterated that the full implementation of the Dole Act remained a priority for the Committee. She also restated the Committee’s commitment to continued oversight to ensure the VA followed through on the law’s provisions.

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