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“Protecting Veteran Choice: Examining VA’s Community Care Program”

Senate Veterans Affairs Committee Hearing

January 28, 2025 (recording here)

HEARING INFORMATION

Witnesses & Written Testimony (linked):

• Eric Golnick: Veteran

• Paige Marg: Veteran Spouse

• Jim Lorraine: President & Chief Executive Officer, America’s Warrior Partnership

• Naomi Mathis: Assistant National Legislative Director, Disabled American Veterans

• John Eaton: Vice President for Complex Care, Wounded Warrior Project

Keywords mentioned:

• VA MISSION Act, suicide prevention, residential rehabilitation treatment programs (RRTPs), interoperability, bureaucratic hurdles, standardized practices, continuity of care, informed choice, accountability

IN THEIR WORDS

OPENING STATEMENTS FROM THE COMMITTEE

• Chairman Jerry Moran called for timely, high-quality care for veterans, particularly in rural areas where VA facilities are scarce. He shared stories of veterans who faced significant barriers in accessing care and illustrated the critical role of the VA’s community care program. He voiced frustration that after seven years, the VA MISSION Act was still not fully implemented and that VA restrictions had worsened access to care like mental health services. The Chairman introduced new bipartisan legislation to strengthen the VA MISSION Act and improve access to both VA and community care for veterans in need.

• Ranking Member Richard Blumenthal stressed the urgency of improving access to community care and ensuring that veterans receive the timely treatment they deserve. He criticized the Trump administration for freezing federal aid for critical veterans' programs, arguing that this decision jeopardized healthcare, suicide prevention efforts, and housing support for veterans. He warned that the erosion of VA direct care, whether gradual or sudden, could become irreparable if not addressed. Ranking Member Blumenthal called for bipartisan action to unfreeze funding, restore oversight by the VA Inspector General, and support legislative efforts to streamline and safeguard access to care.

SUMMARY OF KEY POINTS

• Eric Golnick shared his experience of waiting over a year to see a therapist after leaving the military, despite being able to access a psychiatrist quickly. He described the dangers of delayed mental health care, noting that timely intervention could mean the difference between life and death for veterans struggling with PTSD and substance use disorders. Mr. Golnick co-founded Forge Health to address these issues but observed that inconsistencies in the VA’s implementation of the VA MISSION Act caused unnecessary delays. He advocated for standardized referral processes, improved communication between VA and community providers, and better outreach to ensure veterans are aware of their care options.

• Paige Marg recounted the struggles her husband, Charlie, faced in obtaining mental health care through the VA after his military service. She told the Committee how Charlie was repeatedly denied long-term counseling, forced to restart treatment with new providers, and ultimately attempted suicide in a VA parking lot after failing to secure immediate help. The VA denied his request for residential treatment, but the Wounded Warrior Project stepped in to cover the cost of life-saving inpatient care. Ms. Marg criticized the VA’s fragmented and inadequate mental health services, questioning how many veterans must suffer before real change is made.

• Jim Lorraine emphasized the importance of giving veterans control over their healthcare choices, arguing that community care provides vital options for those who distrust or struggle to access the VA. He reviewed widespread frustrations with long wait times, cancellations, and administrative hurdles that prevent veterans from receiving timely care. Mr. Lorraine noted that veterans are increasingly seeking care outside the VA, and he urged Congress to codify access standards, eliminate referral delays, and allow veterans to use TRICARE Select for community care. He stated that improving veteran healthcare is a national security issue and essential for maintaining an all-volunteer military.

• Naomi Mathis acknowledged the increasing reliance on community care due to the growing demand for VA services. However, she pointed out that veterans often face barriers such as denied eligibility, scheduling delays, and billing issues when seeking care outside the VA. Ms. Mathis called for better training for VA employees to ensure proper implementation of the VA MISSION Act, improved electronic health record systems to streamline referrals, and stricter requirements for community providers to meet VA’s suicide prevention and trauma-informed care standards. She stressed that while community care is important, a strong VA healthcare system must remain the foundation of veteran care.

• John Eaton discussed the difficulties veterans face in accessing mental health care through the VA, particularly in securing appointments in a timely manner. He said that provider turnover at VA facilities disrupts continuity of care, forcing veterans to repeatedly start over with new clinicians. Mr. Eaton highlighted the challenges in accessing VA Residential Rehabilitation Treatment Programs (RRTPs), where referrals are often denied despite urgent needs. He urged Congress to apply VA MISSION Act access standards to RRTPs, ensuring that veterans can receive the specialized care they require without prolonged delays.

• Chairman Moran asked Ms. Marg if the VA had denied her husband’s care. Ms. Marg confirmed this was true, despite her husband’s 70% service-connected disability rating, which had since increased to 100% due to individual unemployability. She recounted that a nurse practitioner told them that the VA did not handle long-term mental health well and directed them to search for providers on Psychology Today. Chairman Moran expressed concern that the VA could have referred Charlie to a facility that was already part of the VA Community Care Network.

• Chairman Moran inquired whether the VA had the authority to refer Charlie to the same facility where TRICARE eventually covered his treatment. Mr. Eaton confirmed that under the VA MISSION Act, the VA could have made that referral. However, he pointed out that inconsistencies in the VA’s access standards led to ambiguity, which left veterans without clear pathways to necessary care. Ms. Marg added that her husband’s treatment facility had a veteran-specific program, while other veterans there had their care fully covered by the VA.

• The Chairman asked if other veterans experienced similar difficulties, or if Charlie’s case was an exception. Mr. Golnick affirmed that inconsistencies in VA education and implementation of the VA MISSION Act led to disparities in veterans' access to care. He noted that some VA Medical Centers (VAMCs) had strong community care programs, while others actively discouraged referrals, creating an uneven standard across the system.

• The Chairman then inquired about whether the VA’s standard treatment approach for veterans with mental health needs was often limited to opioid prescriptions. Mr. Eaton acknowledged that, in many cases, opioids were overused for treatment, especially in persistent mental illness cases. Chairman Moran suggested that the VA’s reliance on opioid treatment contributed to its failure in providing comprehensive care.

• Ranking Member Blumenthal urged for accountability at the VA and asked if firing the VA Inspector General (IG) weakened oversight. Mr. Eaton agreed, stating that the IG played a crucial role in ensuring accountability for both VA care and community care spending. Ranking Member Blumenthal highlighted that private-sector care also required oversight, as delays in community care referrals sometimes exceeded VA wait times.

• The Ranking Member pointed out that veterans needed timely, high-quality care and questioned whether both the VA and private-sector care systems needed to be complementary rather than competitive. Mr. Eaton agreed, stating that clear standards and consistent access were necessary to prevent veterans from being lost in the system. Ranking Member Blumenthal further criticized a hiring freeze that restricted essential VA positions, such as psychologists and social workers, and underscored that a recent funding freeze affected suicide prevention programs.

• Sen. Bill Cassidy asked about the effectiveness of the VA’s telehealth and telemental health programs, which were intended to increase access, particularly in rural areas. Mr. Golnick responded that telehealth could be helpful, but veterans should have the choice between in-person and virtual care. Ms. Marg added that while her husband had used telehealth, he preferred in-person visits for mental health treatment. Mr. Eaton noted that licensing issues could sometimes limit the availability of telehealth providers across state lines.

• Sen. Cassidy raised concerns about high turnover among VA mental health providers, which disrupted continuity of care. Mr. Lorraine explained that turnover occurred both within VA facilities and across different locations in the VA system, creating instability for veterans trying to maintain treatment relationships. He stated that continuity of care was crucial and that VA provider turnover exacerbated delays and inconsistencies in treatment.

• Sen. Ruben Gallego, drawing on his own experiences as a veteran, asked Mr. Golnick to elaborate on inconsistent VA implementation of community care policies. Mr. Golnick explained that some VA facilities fully embraced community care, while others actively discouraged it, leading to disparities in access. He suggested standardizing referral processes to prevent veterans from facing unnecessary bureaucratic barriers.

• Sen. Gallego asked if community care providers received standardized training to treat veterans' specific conditions. Ms. Mathis confirmed that community providers were only required to have opioid abuse treatment training, whereas VA direct-care providers received additional specialized training. She warned that community providers might lack military cultural competence, which could lead to misdiagnosing or overlooking critical mental health issues.

• Sen. Tommy Tuberville asked how Ms. Marg communicated with other military families who shared similar struggles. Ms. Marg stated that when veterans and their families shared experiences, it was evident that issues with VA care were widespread rather than isolated incidents. She noted that every step of her husband’s care had been a struggle, leading some veterans to give up entirely.

• Sen. Tuberville questioned why, after billions of dollars in investments, the VA still struggled with transferring records between the Department of Defense (DoD), VA, and community care providers. Ms. Mathis responded that while the VA and DoD had improved communication, records were still not properly shared between VA and community care providers. She noted that veterans were often responsible for transferring their own medical records, which created unnecessary burdens and delays.

• Sen. Tammy Duckworth emphasized that veterans needed to be informed about their care options and asked how the VA could improve veteran education on healthcare choices. Mr. Golnick argued that VA staff at the ground level wanted to help veterans but were often hindered by bureaucratic inefficiencies at higher levels. He suggested a comprehensive education program within the VA to ensure both veterans and VA employees understood community care options and the process for obtaining them.

• Sen. Marsha Blackburn proposed that veterans should have direct ownership of their medical records to reduce administrative burdens and delays in accessing care. Ms. Mathis agreed that veterans often struggle to retrieve their records and that better systems are needed.

• Sen. Blackburn criticized the VA for slow processing times, blaming union bureaucracy and inefficiencies. She then asked Mr. Golnick for three specific recommendations to improve access to care. Mr. Golnick suggested educating veterans about their healthcare options, codifying access standards to eliminate ambiguity, and ensuring that VA administrators prioritize veterans' needs over financial or bureaucratic concerns.

• Sen. Angus King expressed frustration with the lack of comprehensive data comparing VA direct care to community care in terms of cost, wait times, and quality. Ms. Mathis confirmed that there was no accountability for tracking data from community care back into the VA, making it difficult to evaluate the system's effectiveness. Sen. King also criticized the ongoing hiring freeze, stating that limiting staffing at the VA would only exacerbate access issues rather than improve them.

• Sen. King pointed out that private-sector healthcare also faces provider shortages, making it unrealistic to assume community care alone could fully meet veterans' needs. Mr. Eaton agreed, reiterating the importance of balancing VA direct care with community care and ensuring that veterans have a seamless, coordinated system of treatment. Sen. King warned against hollowing out the VA system in favor of privatization, stating that investment in VA facilities was essential for maintaining high-quality care.

• Sen. Kevin Cramer highlighted challenges specific to rural veterans, particularly in North Dakota, where veterans often live hundreds of miles from the nearest VA hospital. He proposed utilizing critical access hospitals more effectively to provide care for veterans. Mr. Lorraine supported the idea, emphasizing the importance of ensuring veterans could receive treatment close to home with the support of family and local healthcare providers.

• Sen. Maggie Hassan asked Mr. Eaton about the impact of provider shortages on veterans' access to mental health care. Mr. Eaton stressed that the availability of consistent, high-quality mental health providers was crucial, as veterans needed to build trust and rapport with their clinicians.

• Sen. Hassan then asked Ms. Mathis about the role of community care in rural areas. Ms. Mathis reaffirmed that community care was essential in places without full-service VA hospitals, but she claimed that it should complement, not replace, VA care.

• Sen. Jim Banks asked why the VA was so bureaucratic and what could be done to change its culture. Mr. Golnick explained that while clinical staff were committed to veterans, administrative inefficiencies created barriers to care. He suggested codifying access standards to ensure consistency across VA facilities. When asked how to change VA culture, Mr. Golnick said that VA leadership needed to enforce directives more strictly and ensure that policies were uniformly implemented.

• Sen. Banks inquired whether community care was too expensive for the VA system. Mr. Lorraine responded that, while it currently accounts for 40% of VA healthcare services and 25% of the budget, the long-term benefits of local, high-quality care outweighed the costs. He argued that community care should not be viewed as a competitor to VA care but rather as a necessary supplement to fill gaps in service.

• Sen. Banks then asked what VA policies needed to change to ensure VA direct care and community care were complementary rather than competitive. Mr. Eaton recommended standardizing access policies across the VA system and ensuring that community care decisions were based on veterans' medical needs rather than administrative or financial factors. He also called for better coordination between VA and community care providers.

• Ranking Member Blumenthal expressed concerns that shifting too much care to community providers would erode the VA system. He asked if witnesses agreed that VA facilities should be maintained at a high standard while also allowing for community care. Mr. Lorraine disagreed, arguing that it was unrealistic to expect the VA to build enough facilities to meet every veteran’s needs. However, Ranking Member Blumenthal clarified that his goal was not to eliminate community care but to ensure that existing VA facilities provided excellent care while community care remained an option.

• The Ranking Member echoed concerns about recent federal funding freezes that affected suicide prevention programs and community care resources. Mr. Eaton confirmed that the funding freeze had already disrupted critical healthcare services for veterans, including addiction treatment and suicide prevention programs.

• Chairman Moran asked whether VA administrators were pressuring providers to minimize community care referrals. Mr. Eaton confirmed that clinicians had reported administrative interference in referral decisions, leading to longer wait times or inappropriate care placements. Chairman Moran criticized the VA for prioritizing administrative concerns over veterans' well-being and reiterated that the VA MISSION Act was designed to ensure that veterans and their providers—not VA administrators—determined the best course of care.

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