[House Hearing, 119 Congress]
[From the U.S. Government Publishing Office]
DELIVERING FOR VETERANS AND
CAREGIVERS: YEAR ONE OF THE DOLE ACT
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HEARING
BEFORE THE
SUBCOMMITTEE ON OVERSIGHT AND
INVESTIGATIONS
OF THE
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED NINETEENTH CONGRESS
SECOND SESSION
__________
WEDNESDAY, MARCH 4, 2026
__________
Serial No. 119-49
__________
Printed for the use of the Committee on Veterans' Affairs
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available via http://govinfo.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
63-836 WASHINGTON : 2026
=======================================================================
COMMITTEE ON VETERANS' AFFAIRS
MIKE BOST, Illinois, Chairman
AUMUA AMATA COLEMAN RADEWAGEN, MARK TAKANO, California, Ranking
American Samoa, Vice-Chairwoman Member
JACK BERGMAN, Michigan JULIA BROWNLEY, California
NANCY MACE, South Carolina CHRIS PAPPAS, New Hampshire
MARIANNETTE MILLER-MEEKS, Iowa SHEILA CHERFILUS-MCCORMICK,
GREGORY F. MURPHY, North Carolina Florida
DERRICK VAN ORDEN, Wisconsin MORGAN MCGARVEY, Kentucky
MORGAN LUTTRELL, Texas DELIA RAMIREZ, Illinois
JUAN CISCOMANI, Arizona NIKKI BUDZINSKI, Illinois
KEITH SELF, Texas TIMOTHY M. KENNEDY, New York
JEN KIGGANS, Virginia MAXINE DEXTER, Oregon
ABE HAMADEH, Arizona HERB CONAWAY, New Jersey
KIMBERLYN KING-HINDS, Northern KELLY MORRISON, Minnesota
Mariana Islands
TOM BARRETT, Michigan
Jon Clark, Staff Director
Matt Reel, Democratic Staff Director
SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS
JEN KIGGANS, Virginia, Chairwoman
AUMUA AMATA COLEMAN RADEWAGEN, DELIA RAMIREZ, Illinois, Ranking
American Samoa Member
JUAN CISCOMANI, Arizona TIMOTHY M. KENNEDY, New York
KEITH SELF, Texas HERB CONAWAY, New Jersey
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
hearing records of the Committee on Veterans' Affairs are also
published in electronic form. The printed hearing record remains the
official version. Because electronic submissions are used to prepare
both printed and electronic versions of the hearing record, the process
of converting between various electronic formats may introduce
unintentional errors or omissions. Such occurrences are inherent in the
current publication process and should diminish as the process is
further refined.
C O N T E N T S
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WEDNESDAY, MARCH 4, 2026
Page
OPENING STATEMENTS
The Honorable Jen Kiggans, Chairwoman............................ 1
The Honorable Delia Ramirez, Ranking Member...................... 3
WITNESSES
Panel I
Dr. Thomas O'Toole, Acting Assistant Under Secretary for Health
for Clinical Services, Veterans Health Administration, U.S.
Department of Veterans Affairs................................. 5
Accompanied by:
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 Benefits Administration, U.S. Department of
Veterans Affairs
Ms. Sharon Silas, Director, Health Care, U.S. Government
Accountability Office.......................................... 7
APPENDIX
Prepared Statements Of Witnesses
Dr. Thomas O'Toole Prepared Statement............................ 25
Ms. Sharon Silas Prepared Statement.............................. 28
Statements For The Record
Elizabeth Dole Foundation Prepared Statement..................... 49
DELIVERING FOR VETERANS AND
CAREGIVERS: YEAR ONE OF THE DOLE ACT
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WEDNESDAY, MARCH 4, 2026
Subcommittee on Oversight and
Investigations,
Committee on Veterans' Affairs,
U.S. House of Representatives,
Washington, DC.
The subcommittee met, pursuant to notice, at 2:45 p.m., in
room 360, Cannon House Office Building, Hon. Jen Kiggans
[chairwoman of the subcommittee] presiding.
Present: Representatives Kiggans, Radewagen, Ciscomani,
Self, Ramirez, and Kennedy.
OPENING STATEMENT OF JEN KIGGANS, CHAIRWOMAN
Ms. Kiggans. Good afternoon, everyone. This subcommittee
will come to order.
I would like to welcome everyone to this subcommittee
hearing to discuss the implementation of the Senator Elizabeth
Dole 21st Century Veterans Healthcare and Benefits Improvement
Act. This landmark bill, led by House Republicans and my friend
Representative Ciscomani from Arizona, made a slew of changes
at the U.S. Department of Veterans Affairs (VA) to modernize
healthcare delivery, especially for aging veterans.
First, I would like to take a pause and ask that everyone
joining us that we keep the servicemembers deployed to the
Middle East and in harm's way in our thoughts and in our
prayers, as well as the families of the six servicemembers who
recently gave their lives.
Today's hearing is about oversight, accountability,
ensuring that the promises Congress made to veterans,
caregivers, and their families are fully realized. While
veterans and their caregivers are beginning to feel the
benefits of this legislation, VA and Congress' work is not
done. Last year Congress passed with bipartisan support the
Dole Act with the goal of improving veterans' access to
education, healthcare, and programs designed to prevent and
reduce veteran homelessness. This was a sweeping, bipartisan,
bicameral package negotiated and supported by members in both
the House and the Senate, Democrats and Republicans alike,
united by a shared commitment to those who served.
The Dole Act represented one of the most comprehensive
veterans reform package in recent years and I was proud to
support it. This legislation moves the needle to modernize VA
healthcare delivery, strengthen support for caregivers, expand
access to education and job training, improve long-term care,
address rural health disparities, and reduce veteran
homelessness. It was designed to make systemic improvements,
not incremental tweaks across the continuum of care for
veterans and their families.
The Dole Act included my Caregiver Outreach and Program
Enhancement Act, or COPE Act, which intended to establish a
grant program to provide mental healthcare to family caregivers
supporting their veteran family members. The COPE Act was meant
to recognize that when we care for veterans, we must also
support those who care for them. Family caregivers are the
backbone of our long-term care system, often sacrificing
careers, financial stability, and their own health to support
their loved ones.
As a veteran, the daughter of a veteran, the wife of a
veteran, and the mom to a future veteran and a healthcare
provider, I understand the importance of investing in our
veteran communities to improve health outcomes. I understand
firsthand the sacrifices military families make and the strain
that caregiving can place on spouses and loved ones. That
perspective makes oversight of this law not just a policy
responsibility for me, but a personal one.
To my dismay, it appears the VA has not followed the
congressional intent of the COPE Act yet and, to my knowledge,
has not followed many other provisions within the Dole Act. Now
I am asking the VA to follow congressional intent and fulfill
all statutory promises in the Dole Act, and today we will
hopefully get a follow-up and hear about the progress that is
being made.
Failure to carry out the will of Congress is unacceptable
and I hope my colleagues will be united in demanding
accountability from the VA. Passing a bill and having it signed
into law is only one part of our job, sometimes the easiest
part. The most important part of our responsibility is ensuring
that the law is faithfully and efficiently implemented in full
alignment with congressional intent on behalf of the veterans
and families it seeks to benefit. Oversight is not optional. It
Is a constitutional obligation. Today's hearing is about making
sure this landmark law does not fall short in execution.
Over a year after enactment, 55 out of 72 sections are
currently in progress. The VA says it is on track to implement
most sections within the timeframes required, but two on track
sections are set to expire in less than a year. Section 106,
which would increase access to dental care, is set to end
January 2027, and it is my understanding that only one phase of
the pilot program has been rolled out. Section 143, which
covers ambulance costs for veterans in rural areas, is set to
sunset in September of this year. The VA has not fully
implemented this provision.
These are not minor provisions. These are real benefits
affecting real veterans: access to dental care, emergency
transportation in rural communities, and essential services
that directly impact health outcomes. When implementation lags
and sunset dates approach, veterans are the ones who pay the
price.
Another eight sections have been marked as at risk or
behind schedule. For example, the Veteran Employment Through
Technology Education Courses (VET TEC) Pilot Program to improve
short-term training and employment opportunities in specialized
high-tech fields is behind schedule, putting implementation at
risk.
Congress and this committee are delivering on the promises
we have made to the veteran community. The VA needs to mobilize
and fully implement the Dole Act. This bipartisan, bicameral
package was meant to drive sweeping improvements, not sit in
prolonged implementation. Veterans, caregivers, and their
families upheld their end of the bargain through service and
sacrifice. Congress upheld its end by passing comprehensive
reform. Now the VA must uphold its end by executing the law
with urgency, transparency, and accountability.
Today, we are not here to relitigate the merits of the Dole
Act. We are here to ensure that it succeeds because the true
measure of this legislation will not be the vote tally that
passed it, but whether veterans on the ground feel the
difference in their daily lives. I look forward to hearing from
our witnesses about concrete timelines, measurable benchmarks,
and the specific steps the VA is taking to ensure that every
section of this law is implemented as Congress intended.
I now recognize Ranking Member Ramirez for her opening
comments.
OPENING STATEMENT OF DELIA RAMIREZ, RANKING MEMBER
Ms. Ramirez. Thank you, Chair Kiggans.
It has been 225 days since our last Oversight and
Investigations Subcommittee hearing, so it is critical that we
are back finally at dais. A lot has happened since our last
subcommittee hearing. Secretary Collins has continued to
attack, erode, and disrespect the VA workforce. He has tried to
strip away veterans' earned benefits through a cruel Interim
Final Rule (IFR), only to be swiftly met with so much
opposition from veterans in Congress that he was forced to
retreat. We witnessed U.S. Department of Homeland Security
(DHS) and U.S. Immigration and Customs Enforcement (ICE)
terrorize our communities, including our veterans, and execute
one of our neighbors, including Alex Pretti, a VA nurse.
Now the President has started an illegal war with Iran to
consolidate power, enrich himself and his donors. He is sending
servicemembers into harm's way. I am concerned that because of
Secretary Collins' leadership, what is left of VA will not be
adequate to meet servicemember needs when they return.
Why am I concerned? Let me tell you why, because Secretary
Collins' legacy thus far has been dismantling VA and eroding
veteran benefits instead of improving the lives of the veterans
we are supposed to be serving. That much is clear from the fact
that the VA has not made much progress in implementing the
bipartisan Dole Act since it was signed into law over 14 months
ago. In defiance of Congress' authority, the vast majority of
the law has not been, in fact, implemented, leaving the most
vulnerable veterans without the resources that Congress
approved for them.
Let us start, for example, veteran homelessness. In the
Dole Act, we included bills from my Democratic colleagues that
gave VA crucial authorities that communities need to address
and end veteran homelessness. We actually increased the Grant
Per Diem (GPD) rate and authorized the VA to purchase basic
necessities for homeless veterans. Having been the executive
director of a homeless service agency myself, I understand that
oftentimes organizations have to do more with less. I know that
every resource and every dollar matters when you are trying to
provide the best service possible with very limited means.
VA worked with committee staff for over a year to refine
the homeless sections of the Dole Act before it was signed into
law. The VA assured us that providing these increased resources
to community providers and to homeless veterans would be simple
as a, quote, ``turning on a light switch'' once the bill would
pass. Under the Biden administration, VA was prepared. Yet
under Collins' disappointing, dysfunctional, and delinquent
leadership, it has taken over a year to implement the most
critical parts of the Dole Act.
Homeless service providers are left receiving a paltry $85
a day to provide transitional housing services to veterans
instead of the $128 a day we had actually authorized in the
law. Community providers are left with the GPD program--
community providers have left the GPD Program in droves while
they waited for the relief promised by Congress. Those exits
create service gaps that are impacting our veterans every
single day.
Communities view VA Undersecretary Collins as an unreliable
partner in the fight to end veteran homelessness and, frankly,
I agree with them. Due to his delays, homeless veterans are
also left without access to their basic needs, another critical
resource Congress authorized in the Dole Act. We gave VA the
authority to use funds to be able to pay for food, for shelter,
for clothing, for transportation for homeless veterans to get
to and from job interviews or for medical appointments. Every
single day that passes, and Doug Collins fails to implement
approved provisions of the Dole Act, he is defying
congressional authority. Every day that passes that a veteran
experiences homelessness on the streets of our country, they
are left without the resources that they need to become stably
housed. That, to me, is shameful, it is irresponsible, and it
is a harmful failure of the Secretary.
Let me talk to you about another shameful note. I want to
discuss the staffing provisions of the Dole Act that have yet
to be implemented. You see, section 146 required VA to develop
and implement staffing models to ensure VA has the workforce it
needs to provide care and benefits to the veterans. Staffing
models are essential for aligning personal resources so they
can be used efficiently, so that the workers with the right
skills are in the right place at the right time.
Folks listening may recall that the Veterans Health
Administration (VHA) is currently undergoing a massive
reorganization, which we discussed at a full committee hearing
just last month. One would think that a reorganization of this
magnitude of the largest integrated health system in the
country would incorporate staffing models. By VA's own
admission, they have not complied with the Dole Act and lack
staffing models for the vast majority of the medical facilities
service lines.
Which begs the question, what is the evidence that the VHA
reorganization is, in fact, needed? How can we be sure that the
VA is making the correct changes if its leadership does not
even know how many staff it needs and where they need them?
Even worse, let me ask you this question. Why is VA cutting
vacant positions if they do not have staffing models developed?
VA provided data to my staff a couple weeks ago and over
26,000 positions that were cut from the books. The details of
those cuts are alarming. For months, VA has told us that these
are quote, ``old COVID era vacancies for positions that are no
longer needed at the agency.'' Let me tell you that the data,
it paints an entirely different picture about the same nature
of these cuts. You see over 18,000, not hundred, 18,000 of the
positions VA cut had a person in that job in 2025 or even 2026.
This included positions for nearly 3,000 nurses, 800 social
workers, 300 psychologists, and over a thousand physicians who
were on the job in 2025. These VA positions were discarded at
the hands of the Secretary's reckless leadership and they are
not going to be backfilled.
Chair Kiggans, the medical center that serves your
constituents had the most cuts of any VA facility in the
country; 733 of the positions VA cut were at the Hampton VA
Medical Center. At the facilities that serve my constituents in
Chicago, Jesse Brown and Hines, 717 positions were cut. In
addition to those 26,000 positions that were wiped from VA's
books since Secretary Collins was sworn in the VA, he has
showed a net 30,000 employees representing centuries' worth of
experiences. Those losses included over 1,100 doctors, 2,300
registered nurses, 700 more social workers, and nearly 300
psychologists.
All of these cuts and losses were made with no staffing
models in place as required by the law. Cut after cut after
cut, with no analysis of how veteran care and benefits would be
affected. It is the definition of negligence.
The Secretary and his political appointees intentionally
misled and lied to Congress about the nature of these cuts.
Secretary Collins is failing at the most fundamental part of
his job, ensuring that veterans have access to world class care
at the VA. It is why this hearing is so important. It is why we
have to hold them accountable. I look forward to the
conversation that we have in this hearing today.
With that, Chair, I yield back.
Ms. Kiggans. Thank you, Ranking Member Ramirez.
I will now recognize our witnesses on our first panel.
Testifying before us today, we have Dr. Thomas O'Toole, acting
assistant undersecretary for Health for Clinical Services at
the Veterans Health Administration. Dr. Mark Koeniger, acting
assistant under secretary for Health and Patient Services of
the Veterans Health Administration. Mr. Kenneth Smith,
executive director, Education Services at the Veterans Benefit
Administration. We also have Ms. Sharon Silas, director of
health for the U.S. Government Accountability Office (GAO).
Will the witnesses please stand and raise their right hand?
[Witnesses sworn.]
Ms. Kiggans. Thank you and you may be seated. Let the
record reflect that the witnesses answered in the affirmative.
Dr. O'Toole, you are now recognized for 5 minutes to
provide the VA's testimony.
STATEMENT OF THOMAS O'TOOLE
Dr. O'Toole. Good afternoon, Chairwoman Kiggans, Ranking
Member Ramirez, and distinguished members of the committee.
Joining me today are Dr. Mark Koeniger, acting assistant under
secretary for Health and Patient Care Services, and Mr. Ken
Smith, executive director of Education Services at Veterans
Benefits Administration (VBA). It is an honor to be here to
discuss progress implementing the Senator Elizabeth Dole 21st
Century Healthcare and Benefits Improvement Act.
First, thank you for this legislation and what it will
accomplish. Within VA alone, the Dole Act mandates implementing
more than 40 enhancements, new guidelines, or new programs;
executing six new pilot programs; conducting outreach and
releasing new online tools for veterans, patients, and coroner/
medical examiners; and completing 50 new congressional mandated
reports. Given the scope and breadth of the legislation, VA
moved oversight of Dole Act implementation to the Office of the
Secretary, ensuring senior most oversight. As of December 2025,
the new Office of Strategic Initiatives is the responsible
office.
The lack of funding has been a hurdle, requiring us to
change priorities and in some instances use funding from
multiple areas to deliver on some of the sections. That said,
we have made significant progress implementing this important
legislation. Of the 72 sections, VA has fully implemented 25
and we are diligently working on the remaining sections with
significant progress being made. I would like to briefly
highlight key accomplishments within VHA, VBA, and National
Cemetery Administration (NCA), which are leading to
transformative changes for veterans and their families.
Section 101 of the Dole Act eliminated an unnecessary layer
of approval, allowing veterans to access community care when in
their best medical interest.
Section 120 increased coverage for noninstitutional care
alternatives from 65 percent to 100 percent of nursing home
costs and the authority to exceed that cap for veterans with
Amyotrophic Lateral Sclerosis (ALS), spinal cord injuries, and
similar conditions. This enables more veterans to receive care
at home, preserving independence and dignity.
Section 402 expanded per diem payments for homeless
veterans to 133 percent of the State home domiciliary rate and
up to 200 percent for sites identifying--meeting identified
criteria. To date, 150 sites have availed of the 133 percent
increase and 40 sites have applied for the 200 percent rate.
Section 149 requires an independent assessment of the
National Veterans Suicide Prevention Annual Report and
development of a public toolkit for coroners and medical
examiners to improve reporting accuracy. The independent
assessment was completed in January 2026.
VA has experienced some challenges with the implementation
of 143 and to a much lesser extent 129, and we welcome the
opportunity to work with the subcommittee to ensure that VA can
provide the benefits and services intended.
The Dole Act expanded the VA's Native American Direct Loan
Program, giving Native American veterans more opportunities to
purchase, build, improve, or refinance homes on trust land. VA
is also hiring additional coordinators to support these
veterans and their families.
Section 212 reestablished the Veterans Technology Education
Courses program. VA has scheduled implementation of the managed
service claims processing capability for the end of third
quarter 2026 and published the student application in the
Federal Register in December 2025.
VA has also made progress implementing section 215, linking
the GI Bill comparison tool to the Department of Education's
College Navigator and is working to incorporate additional
data.
Of note, VA's conversion from the benefits delivery network
to the Digital GI Bill has impacted full implementation of
sections 208, 210, and 212, as well as recent court decisions.
We will continue to provide updates to Congress in our calls
and briefings.
Section 301 expands burial allowances for veterans who die
at home while receiving VA hospice care, ensuring families
receive timely support.
Section 302 improves outreach to States and Tribal
governments to ensure veterans and their families are aware of
burial and memorial benefits they have earned.
Chairwoman Kiggans and Ranking Member Ramirez, this
concludes my statement. We appreciate the opportunity to speak
before you today and welcome any questions you or other members
of the subcommittee may have. Thank you for your continued
support of veterans, their families, caregivers, and survivors,
and the many VA programs that serve them.
[The Prepared Statement Of Thomas O'Toole Appears In The
Appendix]
Ms. Kiggans. Thank you, Dr. O'Toole.
Ms. Silas, you are now recognized for 5 minutes to provide
your testimony.
STATEMENT OF SHARON SILAS
Ms. Silas. Chairwoman Kiggans, Ranking Member Ramirez, and
members of the subcommittee, thank you for the opportunity to
be here today to discuss VA's progress implementing
requirements in the Elizabeth Dole Act.
The Dole Act authorized significant expansions to
healthcare programs and support for veterans. Today I would
like to highlight GAO's work in two areas that are addressed in
the law: the Veterans Community Care Program and the Caregiver
Support Program.
First, the Dole Act contains a number of provisions for VA
that are intended to improve the agency's healthcare
operations, including community care. Relatedly, GAO has a long
history of review reviewing the Community Care Program,
including some of the more recent changes to how referrals are
processed and appointments are scheduled. In a little more than
10 years, the Community Care Program has tripled in size and
represents nearly 42 percent of all VA healthcare appointments.
With that expansion, the administrative processes at VA
facilities have become more complex and continue to be labor
intensive.
Through this growth, the Veterans Health Administration has
made new, numerous changes to how the program is administered
in order to gain efficiencies and ensure that veterans
understand their healthcare options. In 2020, we issued a
report on VA's implementation of the Veterans Community Care
Program. In that review, we described the timeliness of
processing referrals and scheduling appointments. We made three
recommendations to VA in that report, two that remain open,
including that VHA assess the staffing and resource needed to
process community care referrals and schedule appointments. We
also recommended the agency set standards for monitoring the
appointment scheduling process, including the receipt of care
with a community care provider.
We also issued two reports in 2025 addressing two key VHA
efforts: the establishment of the VHA's Integrated Veteran Care
Office, or IVC; and the Implementation of the Referral
Coordination Initiative.
The creation of the IVC was an organizational reform to
address VHA's progressively complex processes to manage
healthcare delivery at facilities and through the Community
Care Program. It consolidated the management of VA healthcare
delivered in the facilities and through community care with the
intent of improving coordination and ensuring veterans receive
seamless access to care.
The Referral Coordination Initiative was created to ensure
veterans understood their care options and to also create
efficiencies for facilities in processing referrals and
scheduling appointments. In both reports, we highlight
deficiencies in the implementation of these efforts that
ultimately can impact veterans access to care. Recommendations
from both of those reviews remain open.
As VHA prepares to go through additional changes, including
restructuring and the next generation of community care
contracts, it is critical that the agency ensure it has the
effective management structures in place to ensure veterans'
timely access to care. Addressing GAO's outstanding
recommendations and addressing the mandates in the Dole Act
will help VA to ensure veterans receive consistent, high-
quality healthcare.
The second program that I would like to highlight is VA's
Caregiver Support Program. The Caregiver Support Program plays
a critical role in supporting caregivers who assist veterans
who have suffered serious injuries with essential tasks of
everyday living. There are currently about 98,000 caregivers
participating in the program. Given the toll that daily
caregiving can take on caregivers' mental health, ensuring VHA
effectively spreads awareness about the mental health support
it offers to caregivers is essential to ensuring that
interested caregivers participate in the program and they
receive the help that they need. The Dole Act includes a number
of provisions to bolster the supports for caregivers caring for
veterans, including a mandate for GAO to review mental health
support for caregivers.
Our work is ongoing, however, I will preview some
preliminary findings. In our report, we describe a variety of
services to support caregivers' mental health and well being,
such as individual therapy, support groups, respite care, among
others. We also identified some challenges caregivers
experience in accessing the services, including the limited
ability to travel to receive support in person. In our report,
we describe some steps VHA has taken to address these
challenges, such as creating a virtual psychotherapy program
for caregivers.
However, our preliminary findings also show that VHA has
not fully implemented performance management practices for
ensuring veterans and their caregivers are aware of the
program. Effective implementation of performance management
practices is not just a bureaucratic exercise. Following the
practice of setting program goals with targets and timeframes,
collecting data to measure progress toward those goals, and
then using that information to assess results and informed
decisions on any adjustments to those efforts can help to
ensure the program is meeting its intended results: getting
caregivers the support they need.
The requirements for VA in the Elizabeth Dole Act align
with many of the findings and recommendations from GAO's
reviews. VA's adoptions of those recommendations would aid the
Department's progress toward implementing the Dole Act's
provisions.
That concludes my prepared statement. Thank you.
[The Prepared Statement Of Sharon Silas Appears In The
Appendix]
Ms. Kiggans. Thank you, Ms. Silas.
We will now move to questions and I yield myself 5 minutes.
I want to ask a quick question to Mr. Smith. Can you talk,
I know you guys all kind of overviewed some of the work that
the VA has done to implement the Dole Act, and can you just
briefly describe what the education outreach has been, that has
been done to educate veterans, their families, and community
care partners, too, just about these new resources that are
available to veterans? Are we putting pamphlets in waiting
areas or are we sending email? What does that outreach look
like?
I know as a primary care provider we often had a large
group of veteran patients. It was challenging to understand the
resources the VA has out there and we have put so many good
things in place and a lot of good changes in motion. I just
want to know how we are communicating with veterans and their
families that these things are now available.
Mr. Smith. Thank you for the question. For our education
programs, our outreach is predominantly through our website. We
have published a number of--information on our website, as well
as provide marketing to our students directly through email
campaigns. Last, our Veterans Service Organization (VSO)
community, they are a great partner in disseminating
information.
Ms. Kiggans. The VSOs are a good source, and I get the VA
emails as a veteran, married to a veteran. I do not think I
ever visited the VA website before my current job, so I do not
do a lot of visit--I do not know how many veterans out there
actively--maybe if they are Google searching. I just--that
outreach piece, there is a lot of primary caregivers out there,
and there is probably a lot of patients sitting in waiting
rooms. A poster, I am thinking of even the technology
integration we see in waiting rooms, you know, just letting
people know. I think that is one of our hardest parts. We have
great benefits, but what are those benefits, and communicating
that, so.
Keep in mind our primary care, our civilian counterparts as
well, we all take care of veterans. I have a large veteran
community in Hampton Roads, so it was just always a challenge,
you know. I had a great office manager who would do that
research and try to connect with the VA. Even as a veteran
provider, I did not even know all the resources that were out
there, so I think that is half our battle. I am just throwing
that out there.
Then going to Dr. O'Toole, the Dole Act has reoriented VA
healthcare to put the best medical interests first in each
veteran. I applaud the VA for enacting this provision. It saves
lives. However, the VA was marked section 122 complete, and
that is the operative section of my bill, the COPE Act. It has
come to my attention that VA decided not to issue any grants
specifically under this program.
Just wondering, Dr. O'Toole, why that law has not been
fully acted about the grants? There was 10 million--
specifically, there was $10 million appropriated for the
program in Fiscal Year 2025 and another 10 million appropriated
in Fiscal Year 2026. Just wondering where that money went.
Dr. O'Toole. Thank you, Congresswoman. I appreciate that.
That is the awards contract for mental healthcare for family
caregiver support. My colleague, Dr. Koeniger, I believe, is
better situated to comment on that.
Dr. Koeniger. The caregiver support, particularly in the
mental health realm, we have implemented the Virtual Caregiver
Support Program. With that program, we have seen, let me see,
actually almost 29,000 encounters. That is a virtual--most of
those encounters are the virtual program, but caregivers can
also be seen face to face as well. Again, those almost 29,000
encounters, there are over 4,300 unique caregivers tied to
those encounters.
Ms. Kiggans. That is good news. Thank you for that.
Let us see, back to Dr. O'Toole. Section 142, it waived the
pay cap for highly skilled medical staff. Dr. O'Toole, can you
tell us how many waivers the Secretary has made for that? I
know that was a complaint we heard frequently, especially with
our surgeons, anesthesiologists, we have trouble recruiting,
retaining physicians, specialty care physicians who could make
so much more on the outside. We need those people at the VA. I
am just wondering if you update for that.
Dr. O'Toole. Yes, thank you, Congresswoman. First, this is
really important legislation for us, as you know, and the wage
gap between what these highly trained specialists would make in
the private sector versus the VA is only growing.
The challenge and issue for us, quite honestly, is that
many, many more specialty groups and specialists among the
25,000 physicians, for instance, that we have in the VA far
exceed the 300 people. We run the risk of second and third
order consequences if we do not do this right. In particular,
if we are picking out certain groups where, you know, one
provider is afforded the expansion or the cap extension and
others are not, what that may do to the practice.
The other dynamic that we are looking at is how can this be
considered from an enterprise perspective? That if a telecare
service, such as teleradiology, can be used in a rural
community, it is probably going to be a lot more efficient and
effective than trying to extend that cap to a radiologist in a
rural community.
We are actively moving forward on this. I meet with the
under secretary and others to review the parameters for data.
We anticipate having a criteria put forward within the next 1
to 2 months, I am hopeful for, to be able to start awarding
that cap. I do want to pay notice to the fact that, you know,
this is critical because it is going to have to extend beyond
these 300 individuals that are ultimately selected in this
first pass.
Mr. Kiggans. Keep us posted. I know that is an important
part of the program, but thank you.
My time has expired. I will save some for maybe a second
round.
I now recognize the ranking member for 5 minutes of
questioning.
Ms. Ramirez. Thank you, Chairwoman.
Dr. O'Toole, I just want to go ahead and follow up on that.
First, thank you for being here. As you know, a few weeks ago
the Secretary testified before the full committee and in a
back-and-forth with our ranking member, he asked Ranking Member
Takano if he would commit to introducing a bill to raise the
cap on physician pay so that he can compete in the market to
hire more doctors. I want to double down a little bit more on
this conversation, because I know you just started a moment
ago.
In that committee hearing, the Secretary claimed that he
cannot recruit physicians because he does not have the
authority to pay physicians more. I am hearing you talk a
little bit about the 300, but here is the thing. Section 142 of
the Dole Act does authorize the VA to use waivers to increase
pay for 300 physicians. The VA does have the authority to pay
its physicians more already, which actually contradicts the
Secretary's testimony when he said he did not have the
resources or the authority to be able to raise those wages.
It sounds like Secretary Collins apparently does not think
it is important to learn the laws that govern his agency, much
just enact those laws to improve the VA and veteran care. That
gets to my next point. I think you have answered this, but I
just want to make sure that I put this on the record. How many
pay waivers has the VHA requested for physicians under the Dole
Act? It sounds like it is zero. The answer is zero. Correct?
Look, in a request for information provided to my staff on
February 12, the VHA indicated they had not requested or
approved any pay waivers for physicians. I just really need to
reiterate what I said to the Secretary at our hearing last
month. He cannot come to our committee and state that he cannot
hire doctors because he cannot compete in the market when he
will not even use the authorities he already has, that we,
Congress, have given him to make more competitive offers to
attract physicians.
Secretary Collins waited until January 9th of 2026, a year
after the Dole Act was signed into law, to publish the
implementation plan for the authority to make it easier to hire
doctors. It did not seem like there was any real urgency there.
You have to understand why I am concerned here. The
Secretary comes before the committee, and he claims that he
cannot hire doctors, but he will not even use the tools that we
have already given him, authorized them, to make some
competitive offers for a number of these physicians. Instead,
he lost 1,000 doctors and then he wiped 1,500 more physicians
positions from the VA books. It makes no sense, if our goal is
to strengthen the services veterans receive, it makes no sense
to continue to claim, as Doug Collins does, that veteran care
and benefits are not affected when we are hearing from our
constituents on a regular basis, veterans, that they cannot get
appointments at the VA. However, his actions make perfect sense
if Secretary Collins does not want to hire, let me say this
again, does not want to hire doctors because his goal is to
ensure that the VA fails so that he can further dismantle and
maybe even privatize it.
I want to follow up on another piece, and this is more
specifically to Ms. Silas. Ms. Silas, GAO has recommended that
VA assess its community care staffing and resource needs to
ensure timely appointment scheduling for veterans seeking care
and community. My question to you, Ms. Silas, is why is such a
staffing assessment important? How does this recommendation
align with the requirement in the Dole Act for VA to implement
a staffing model in the IVC, Veterans Integrated Service
Networks (VISN), and the local medical facilities?
Ms. Silas. Thank you for that question. An agency's
workforce is really central to an agency transitioning into a
high-performance organization. In GAO's high-risk work, we have
worked with the Veterans Health Administration to try to get
them to be better in terms of clarifying their resource needs.
The staffing model and performance metrics that are provisioned
in the Dole Act are incredibly important because it helps to
align your resources and staff needs with your program needs.
It also is important for being able to plan ahead and to manage
any risks.
As you all know, each VA facility is unique in terms of the
veteran population that they serve and then also in the
communities that they reside in. I know that one thing that we
have heard consistently for as long as I have been doing this
work is that when we meet with staff in these facilities, they
say there is not enough staff to process referrals in a timely
manner and to do timely appointment scheduling. We always hear
about challenges with workload.
In our 2020 report where we recommended that VA assess
their staffing resources, they had told us that they have the
staffing tool and that they were in the process of updating
that, and they have been continually updating that staffing
tool as the processes have evolved over the last 5 years. That
recommendation, as you know, remains open.
For the staffing model and performance metrics that have
been required in the Dole Act, the staffing tool, at the least,
can provide information or input into the staffing models they
are delivering now.
Ms. Ramirez. That makes sense.
Ms. Silas. It is kind of unclear how these both fit in
together. Regardless, GAO does have a mandate in the Dole Act
to do a review of the VA's development of the staffing model
and performance metrics. Once they complete the effort and
issue some reports we will be doing our own review.
Ms. Ramirez. Thank you, Ms. Silas. My time is up. If we
have a second round, I will do a follow-up. Thank you, Chair.
Ms. Kiggans. Thank you, Ranking Member.
The chair now recognizes Mrs. Radewagen for 5 minutes.
Ms. Radewagen. Thank you, Chairwoman Kiggans. Talofa lava.
I thank the panel for being here today. It is an important
hearing today, so thank you to the witnesses as well.
Mr. Smith, what has been the greatest barrier for
implementation of section 302 of the legislation?
Mr. Smith. Thank you for the question, ma'am. Right now, VA
is working to publish a rule for that grant program so that we
can perform or issue grants to perform the veteran outreach as
required by 302.
Ms. Radewagen. How has section 302 helped VA better partner
with State and Tribal entities?
Mr. Smith. I believe that once implemented, we will be able
to provide, or at least provide grants, you know, to those
organizations so that they can perform outreach on VA's behalf
and ensure that they are communicating with their members in a
culturally responsive way.
Ms. Radewagen. Ms. Silas, in GAO's review of the Dole Act
implementation, what has been your greatest concern?
Ms. Silas. The GAO has a number of mandates to review
implementation of various provisions within the Dole Act. Much
of our work that we need to do is either waiting on VA to
complete their enactment of their provision so we can oversee
that or we are waiting for some reports to be released in order
for us to do the review. We have not looked directly at the
implementation of any of the specific provisions that VA is
responsible for.
We do have ongoing work for our own mandates around the
dental services. We are looking at VA's oral health program. We
are also looking at the Veterans Community Care Dentistry
Program. We are making progress on those reviews. Otherwise, we
are waiting for VA to complete their efforts before we look at
them.
Ms. Radewagen. Do you believe that VA will be able to
implement the act in its entirety in the allotted timeframe?
Ms. Silas. I do not think I could state for sure. It would
be up to VA to tell you what their progress is. Again, I can
only speak to the programs that we have oversight of in terms
of the mandate and provisions to review those programs. Most of
that work is ongoing right now.
Ms. Radewagen. Thank you, Chairwoman. I yield back the
balance of my time.
Ms. Kiggans. Thank you, Ms. Radewagen.
The chair now recognizes Mr. Kennedy for 5 minutes.
Mr. Kennedy. Thank you. I want to look back at what we were
told about the VA staffing cuts versus what has actually
happened. In February 2025, Secretary Collins eliminated 2,400
VA jobs after publicly promising that 300,000 mission-critical
positions would be protected to ensure uninterrupted services
for our Nation's bravest. One month later, a leaked memo showed
plans to cut more than 80,000 employees, a number the Secretary
confirmed, then denied, then revised to 30,000.
On May 15, Secretary Collins assured our veterans that
mission-essential jobs, like doctors, nurses, and claims
processors would be protected and that reforms would
strengthen, not strain, veterans access to care. That promise
was broken. In December, a leaked memo revealed plans to
eliminate up to 35,000 healthcare positions in a single month,
the doctors, nurses, and support staff that veterans count on
for timely quality care.
When a psychologist is cut, the veteran in crisis has fewer
options and longer waits. When a community care scheduler is
eliminated, the veteran waiting for a cancer consult or
neurosurgery referral waits longer, sometimes dangerously
longer. When nurses and physicians are cut, the people who
catch conditions early and respond to emergencies are not there
when they are needed most. These are not just workforce
reductions. There are direct cuts to the care our veterans
depend on, sometimes for their lives.
That is why I requested detailed staffing data for the
Western New York VA system to understand exactly how many
positions were cut and how it is affecting veterans in my
district. The VA refused and then days before this hearing, we
received incomplete numbers. What we recently uncovered in my
own district in Buffalo, New York, is demonstrative of what we
are seeing in VA medical centers across the Nation.
On December 14, roughly 100 healthcare positions were
eliminated at the Buffalo VA, 23 active critical roles,
including 2 psychologists, 2 social workers, 1 recreation
assistant, 1 respiratory therapist, 3 physicians, 2 nurses, and
11 Electrocardiogram (EKG) technicians, all cut. These are the
people who treat Post-traumatic Stress Disorder (PTSD),
diagnose heart conditions, coordinate the care that keeps
veterans out of emergencies rooms, and so much more.
We already know what happens when staffing falls short
because we have seen it happen at the Buffalo VA. In 2024, an
Office of Inspector General (OIG) investigation found that
dangerous delays in scheduling community care consults put
veterans at serious risk. This investigation identified
staffing shortages as a key cause of this degradation of care.
Community care schedulers in a follow-up conversation in
response to the investigation told us directly that staff
shortages led to countless untreated patients and devastating
health outcomes, including at least one death.
The Trump administration's response? Eliminate the staff
who schedule the consults, the technicians who conduct exams,
the personnel who ensure psychiatric care, and the
professionals who ensure no veteran is left behind. We know
what happens when those positions go unfilled: veterans care
suffers and some veterans will die. This is not just
mismanagement. It is life and death for the veterans who rely
on the VA for timely care.
Secretary Collins stood before this committee and promised
that the doctors and nurses should who care for our veterans
would not--would be protected. He promised that care for our
veterans would not be cut. He was not telling the truth and our
veterans are the ones paying the price.
I have a very simple question for those here representing
Secretary Collins' VA. When veterans in my district get sick
because of a lack of resources, which of you will take
responsibility and what are we to tell them?
Dr. O'Toole. Well, thank you, Congressman, and I appreciate
what you are bringing up and I fully acknowledge the challenges
and the issues. If I can, I appreciate--I am hoping for a time
extension to be able to respond to your question, if that is
okay, Chairwoman.
The issue of having enough providers for care is a
significant one. It is one, however, that we share with the
entire American healthcare system. Right now there is an
estimated shortage of physicians, nurses, social workers,
psychologists, psychiatrists, estimated to be at 90,000 over
the next 10 years in the American healthcare system. What we
are challenged by in the VA is what all of American healthcare
is challenged by. I think that is an important consideration to
make. It is why I also, you know, emphasize the importance of
section 142 in really trying to help us be to be more
competitive in attracting people to come in. It is absolutely
important.
I do need to emphasize, though, and clarify. When the
Deferred Resignation Program (DRP) process went through, those
clinicians who were involved in direct care with providers--
with patients were not allowed to pursue the DRP. Those
requests for DRP were denied by those direct clinicians. That
does not mean that people are not going to retire. That does
not mean that people--that positions are going to attrit or
that people may leave the VA. We all have workforce challenges
in healthcare, and I do not want to minimize that issue or
point, nor the importance of Congress in helping us navigate
those waters. It is a shared challenge for all of us that
extends beyond this.
The positions that were eliminated were vacant positions
that had not been filled for quite some time. That does not
mean that people were losing their jobs. I do think that is a
really important clarifying point to the issues that I think
are very valid that you are bringing up.
Ms. Kiggans. Thank you, Dr. O'Toole.
The chair now recognizes Mr. Self for 5 minutes.
Mr. Self. Thank you. Thank you, Madam Chair.
Dr. O'Toole, I do not question the President's authority to
use impoundment. I just want to clarify. None of what we are
hearing is an impoundment under the Dole Act, is it?
Dr. O'Toole. I am sorry, Congressman, I am not sure I am
following your question. Can you please----
Mr. Self. Congress authorizes a certain level. The
President decides to spend less than that level. Is that--is
impoundment involved here? Just to clarify.
Dr. O'Toole. Not that I am aware of at all, sir.
Mr. Self. Very good. I want to go to your written versus
your verbal testimony. I think I heard something that is not in
your, excuse me, your written testimony. It is in the
paragraph, I believe, where you talked about VA using funding
from multiple accounts to deliver on some of the sections. Now,
in your verbal testimony, you said lack of funding. Can you
clarify what you said in that paragraph?
Dr. O'Toole. Thank you, Congressman. You know, obviously,
you know far better than I, you know, the dynamics of
appropriations, and I am not trying to speak to that. Some of
the provisions in the Dole Act did not involve appropriated
funds. We have tried to implement within the capacities that we
have to the best of our abilities or if funds were available
through other accounts, use those and just trying to be
fiscally prudent within that context. I want to defer to my
colleagues who might be able to speak better to that.
Mr. Smith. Thank you. For the Digital GI Bill program, we
are required to make changes to that environment in order to
implement----
Mr. Self. No, I am not asking for specifics. Thank you. I
just wanted to clarify your lack of funding. You did say that,
I believe, and I am not sure you clarified it, but thank you.
I want to move to accountability in the 3 minutes I have
left because we talk a lot in this committee about inputs. We
get VA employees coming and telling us about all the inputs.
Who is going to be accountable for this?
This bill was to improve ability to receive care at home.
Correct? If you believe that changes in the fee schedule for
reimbursement rates related to home health aid and homemaker
services were to result in a reduction of up to 43 percent in
rural Texas, some of which I represent, do you believe that
that improves a veteran's ability to receive home healthcare?
How is that balanced?
Dr. Koeniger. Sir, thank you for the question. I cannot
speak directly to veterans in Texas in terms of receiving home
healthcare. I can say, though, that the home and community-
based services, the VA has done actually a great job at
expanding those services. The----
Mr. Self. Do you think the 43 percent reduction is going to
improve their ability to receive home healthcare?
Dr. Koeniger. So the--again, I----
Mr. Self. Okay.
Dr. Koeniger [continuing]. cannot speak specifically to
that, but I can say that, again, over--compared to Fiscal Year
2024, over roughly 600,000 veterans have actually benefited
from the home----
Mr. Self. Okay.
Dr. Koeniger [continuing]. and community-based services.
Mr. Self. Very good, thank you.
Dr. O'Toole, can you name the specific individuals who, in
VA, who are going to be responsible for each of the at-risk
sections?
Dr. O'Toole. Thank you, Congressman. As I mentioned in my
opening statement, we have a centralized office, Office of
Strategic Initiatives, that is overseeing this process. All of
our senior leadership are fully engaged in this and as the
committee staff would know, meet with frequently. I am more
than happy to forward to you the org chart that delineates
specific----
Mr. Self. No, I do not need the org chart. I am asking you
if you are going to hold someone accountable because you are
about one-third of the way through implementation. Is that
about right? One-third of the way through in terms of sections?
Dr. O'Toole. Sure.
Mr. Self. What I am really asking is who is going to be
held accountable?
Dr. O'Toole. Our senior leaders----
Mr. Self. We always talk about inputs. I want
accountability for when you implement this.
Dr. O'Toole. Our senior leadership throughout the agency
are responsible, sir, including myself.
Mr. Self. Okay. Very good. What is the critical milestone
between now and full--oh, my time is up, Madam Chair. I will
yield back. Thank you.
Ms. Kiggans. Thank you, Mr. Self.
The chair now recognizes Mr. Ciscomani for 5 minutes.
Mr. Ciscomani. Thank you, Chair Kiggans, for convening this
important oversight hearing. Thank you to the witnesses from
the Department of Veteran Affairs and Government Accountability
Office for being here today with us.
I was proud to help introduce the Senator Elizabeth Dole
21st Century Veterans Healthcare and Benefits Improvement Act
last Congress and even more proud to see it passed and get into
law, be signed into law, because I believe strongly that our
veterans and their caregivers deserve a system that truly
reflects the sacrifices they have made for our Nation.
Far too often, veterans and their families face barriers
when trying to access care, navigate benefits, and receive the
superior that they have earned from the VA. This flagship VA
legislation was designed to modernize the VA and create a
system that works, that works better for veterans and their
families and who stand beside them every single day. One year
after enactment, it is important that we take a close look at
how the Department is implementing these reforms.
While progress has been made in several areas, some
provisions remain behind schedule or at risk of not fully being
implemented. For veterans and their families these timelines
matter. Delays can mean waiting longer for care, missing out on
an important support service, or facing unnecessary barriers to
benefits they earned through their service. This is why I want
to ask a couple of the follow-up questions here, and I will
start with Dr. O'Toole.
The Dole Act includes a wide range of reforms touching
clinical care, caregiver support, and community-based services.
How has the VHA prioritized implementation across these areas
to ensure that the most immediate needs of veterans are
addressed first?
Dr. O'Toole. Thank you, Congressman. I want to defer to my
colleague on the community care question, if that is okay.
Dr. Koeniger. That is a great question. In terms of
community care or even caregiver support, I mean, we recognize
that taking care of veterans, no matter what their problems
are, is very important. In terms of the community-based
services, we have four programs that we have rolled out. Those
programs have actually seen an increase, as I mentioned
earlier, in terms of supporting caregivers as well.
Mr. Ciscomani. How do you--I am sorry to interrupt because
we are going to run out of time, but how do you prioritize? How
do you make sure that those that have the most immediate need
of veterans get seen first? What is the process like?
Dr. Koeniger. Again, the veterans that have the highest
needs in terms of medical issues, you know, those are the folks
that we want to make sure that we take care of.
Mr. Ciscomani. I agree. How do you get there? How do you
identify that?
Dr. Koeniger. The specific process I would have to get back
to you on. I mean, certainly----
Mr. Ciscomani. I want to make sure that that is actually
happening. It is just that, you know, I think you get the sense
from the committee here on both sides of the aisle, we are
running a little impatient on the implementation of a lot of
these programs. This was supposed to be a much more expedited
process and seeing the benefits of this. We are not seeing
that. This is coming from every angle and every State
represented here, we are all seeing this in our district. We
need to really zero in on this and we need to start seeing some
results.
I am going to move on here. Dr. O'Toole, again, one of
Congress' goals in the Dole Act was to improve timely access to
care. From your perspective, what measurable changes should
veterans expect to see in appointment availability or service
delivery as implementation continues?
I keep hearing from our veterans the care they receive at
the VA is excellent once they receive it. Receiving it and
getting there is the main issue. Again, I am starting to see a
trend here of what was passed not being enacted. I want to
start seeing some results and so do our veterans. What way are
you measuring this?
Dr. O'Toole. Thank you, Congressman. This is very important
and I think to follow up with your second question as well--or
previous question as well.
This is a massive piece of legislation, as you know, you
know, 72 provisions that impact across the agency. I cannot--I
have been a primary care provider in the VA for 20 years. This
is one of the most significant pieces of legislation I have
seen having impact across the vast entire agency. First, thank
you for that.
As your staff knows and meeting with them and having sat in
on several of the calls, this is something where we have to be
able to chew gum and walk at the same time and implement
multiple efforts concurrently. We are. This has been a
difficult year in both securing our most senior leadership, our
Senate-confirmed leadership, going through the government
shutdown, which created some undue slowdowns in terms of
getting things through. We are on the cusp with several of
these provisions within the next weeks to a month or two to
having them posted in the Federal Register and being
implemented.
Very much I feel confident that we will be able to
implement all of the provisions in the time allowed. They are
priorities for us because they are priorities for our veterans
across many different contexts.
Mr. Ciscomani. I am out of time. I do look forward to
seeing results. You know, I think we understand it. We know the
significance, the size of the legislation. We worked on it. We
passed it. It is big and it is going to take time, we know
that. It has been over a year. We need to see some results
here. You say weeks, months. I hope it is weeks and I hope we
can get a report exactly on numbers and what this matters.
Madam Chair.
Dr. Koeniger. Madam Chair, I know we are over time. Could
I--Congressman, you mentioned access to care and I would just
like to say it is a very complicated process. As you know,
there are just so many things that have to be taken into
account to improve access.
I can tell you that as of May of last year, the Veterans
Health Administration stood up the Access Choices in Excellence
Group of which I am the executive sponsor and we have been
working diligently on all aspects of access to care to, again,
objectively measure all of those things and to work on
improving access.
As a 36-year veteran of the United States Air Force myself,
that sits--that is near and dear to me to make sure that
veterans can get in when they need to get in.
Mr. Ciscomani. Thank you.
Ms. Kiggans. Thank you. I think we have a few minutes for a
second round of questions. I just have two questions for Dr.
O'Toole.
As a former geriatric nurse practitioner one of my greatest
concerns was ensuring our aging veterans are getting the care
that they deserve. Can you provide the committee just with an
update on the rollout of the pilot program, section 127, to
fortify the assisted living services for veterans and what that
looks like?
Dr. O'Toole. Thank you, Congresswoman. I think--is that in
your scope?
Dr. Koeniger. Yes. Yes. Thank you for the question. As you
know, our population is aging. Again, we have 49 percent of all
our veterans are 65 and older. We are working in terms of the
two pilots as section 127 states. The VA is--has been working
on a purchasing authority and a fee schedule options are under
development because we are--we need to get those things in
place so we can ramp up those pilots. We are making progress
and work in the details of getting the pilots going.
Ms. Kiggans. Okay. We would love to see some movement in
that, too. I think that is important. There are not enough
options, especially housing options, for aging Americans.
Perhaps the VA should hire more geriatricians, but that is just
my two cents.
Then, Dr. O'Toole, our stakeholders have highlighted that
the best medical interest standard is coming into conflict with
transportation benefits that usually accompany care for
disabled veterans. Veterans should not have to sacrifice the
best standard of care because the VA will not pay for
transportation. How does the VA intend to harmonize this
conflict to deliver patient-oriented care?
Dr. O'Toole. Thank you. It is a huge issue and obviously
providing care that somebody cannot get to sort of misses the
mark. We are working specifically and having some challenges
specifically on the transportation provision. I think I
mentioned that in my opening statement, and it is something
that we would like to be able to work with the committee
further to be able to go through those provisions to address
some of the challenges we are having with that implementation.
Ms. Kiggans. That would be great. I think that should
definitely be a priority for us moving forward.
The chair now recognizes Ranking Member for any remaining
questions.
Ms. Ramirez. Thank you, Chair. Here you go.
Dr. O'Toole, I just want to follow up on some of the
conversations we had at the beginning of the hearing.
Specifically I want to talk about my own district. Before the
VA cut the 130 nurses at the Jesse Brown and Hines VA Medical
Centers, did the VA have staffing models in place as required
by the Dole Act to determine that those 130 nurses were no
longer needed at those facilities in Chicago?
Dr. O'Toole. Thank you, Congresswoman. It is important to
keep in mind, particularly as I know a lot of questions about
the staffing model come up in consideration of the Rise
Initiative and the reorganization, there has been no change
whatsoever in terms of direct care staffing modeling based upon
the reorganization efforts under Rise.
Ms. Ramirez. Doctor----
Dr. O'Toole. The----
Ms. Ramirez. Dr. O'Toole.
Dr. O'Toole. The staffing models have--we continue to do.
They are being refined in the context of the Dole Act.
Ms. Ramirez. Did we have staffing models in place there to
determine that we did not need those 130 nurses? It is more of
a yes or no. Just trying to get clarity.
Dr. O'Toole. Ma'am, those positions were not removed. Those
were not active positions. Those were positions that had not
been filled and not have been filled for quite some time.
Ms. Ramirez. I am just looking here at some of the reports
we got from all of you here. For example, there are 41 nurses
positions filled in 2025 or 2026 that were no longer filled
after. These were positions that were--they had bodies in them
prior to the cut of these. Of these nurses, yes or no? Did you
have people working there? Were there nurses working there?
Dr. O'Toole. No.
Ms. Ramirez. Okay. Well, the data says a different--the
thing is that I am looking at the data that you provided for me
for these centers, and so it is inconsistent with what I am
getting from you. Let me just wrap up here because I know we
only have a few minutes and we want to close this hearing.
Dr. O'Toole. We can take that for the record for further
clarification.
Ms. Ramirez. Yes, I would appreciate that.
I want to just come back to housing real quick. You heard
me say I ran a homeless shelter for about 9 years, of which I
had the honor and opportunity to serve many veterans who were
experiencing homelessness. I just want to wrap up with sections
402 and 403 of the Dole Act, which provided the crucial
resources to the VA and community providers who serve homeless
veterans. I want to make sure that it is clear that due to the
delays in implementing these provisions, homeless veterans and
community organizations are having to go without these
resources.
During the Biden administration, the homeless program's
office staff told me and my team repeatedly that it would be
ready to swiftly implement the Dole Act, that it would be like
turning on a light switch. It is hard for me to know that we
are 14 months in, and it sounds like for Secretary Collins it
is going to take over a year to flip a light switch. You know,
to me, it is a testament to poor leadership that homeless
veterans still do not have the resources they need.
Sadly, I know there is something nefarious going on that
led to the delay in implementation of these homeless sections.
Specifically, the administration, including Secretary Collins,
has wielded attack after attack against veterans experiencing
homelessness. They prioritize handcuffs and jail cells over
getting these veterans help that they need in place of getting
them a home. Look, I believe that the swift--and they are
swifting away from interventions that we know have worked
address homelessness, programs like Housing First models. This
administration's focus on programs that have proven time and
time again to actually make homelessness worse are leading the
delay that we see here.
You see, I see that Collins is actively pushing a strip
down, in effect a for-profit model of homeless service delivery
driven by special interest instead of leaving intervention to
the experts in homeless program offices. We know that the VA,
especially the political leadership, meddled in implementation
of the Dole Act is getting in the way of these programs that we
actually know work.
Instead of relying on the expertise of an office that has
housed over 50,000 homeless veterans last year, these political
appointees substituted their poor profit-minded judgment for
expertise. The consequence? Fourteen months of veterans not
having access to the housing, transportation, clothing, and
food that they need. I find that to be unacceptable. Frankly, I
find it to be despicable.
These same political appointees are pushing a dangerous
proposal to destroy Housing and Urban Development-Veterans
Affairs Supportive Housing (HUD-VASH), the most successful
permanent supportive housing program in the history of this
country and replacing it with a poorly conceived program that
we know will fail called Bridging Rental Assistance for Veteran
Empowerment (BRAVE).
I want to make sure, on the record, in the last few seconds
I have, that I am going to tell you I am going to continue to
defend our homeless veterans. They should not be homeless to
begin with. We cannot sit here idly watching this
administration destroy these programs so that billionaire
buddies can get enriched as a result of it
I look forward to getting an update in the immediate future
that the VA has fully implemented the homeless sections of the
Dole Act and has abandoned the BRAVE proposal because anything
less is a disgrace and a disservice to our most vulnerable
veterans.
With that Chairwoman, I yield back.
Ms. Kiggans. Thank you. I just wanted to take a minute to
thank the witnesses for coming today. I appreciate the candor
in your testimony and your willingness to participate.
Implementing the Dole Act remains a top priority of this
committee. I look forward to continuing to ensure the VA
remains committed to this goal. Thank you all for being here
today.
I ask unanimous consent that all members shall have 5
legislative days in which to revise and extend their remarks.
Did you have any concluding remarks, sorry, as well?
Ms. Ramirez. I do, Chairwoman, thank you.
As I reflect back on the hearing, our first one in over 200
days, I am struck by some of the answers that were received
here. First, Dr. O'Toole, you said that no doctors or nurses
were allowed to take the Deferred Resignation Program. However,
data the VA has provided themselves to Mr. Kennedy shows that
two nurses from Buffalo were allowed to take the DRP last year.
You also reiterated that the Secretary's talking point that
many of these positions eliminated were not filled in a long
time. However, again, the data that has been provided by you
all says the opposite. Seventy-one percent of these 26,000
positions were filled at some point since January 2025. If
these were really COVID era positions, then why were these
positions still there? Specifically, I am thinking about the
Jesse Brown/Hines positions.
Look, I am glad that we are here. I know that we are going
to go ahead and follow up. I think that the work that we do in
this committee is incredibly important because we have to
implement every facet and every provision of the Dole Act.
Twenty-five of the 72 is unacceptable. I look forward to
following up with you to make sure that you take the urgency
necessary to implement every single section so that our
veterans have what they, in fact, need and they deserve.
With that, I yield back.
Ms. Kiggans. Thank you all again for being here today. I
ask unanimous consent that all members shall have 5 legislative
days in which to revise and extend their remarks and include
any extraneous material. Hearing no objection, so ordered.
The hearing is now adjourned.
[Whereupon, at 3:55 p.m., the subcommittee was adjourned.]
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A P P E N D I X
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Prepared Statements of Witnesses
----------
Prepared Statement of Thomas O'Toole
Good afternoon, Chairwoman Kiggans, Ranking Member Ramirez, and
distinguished members of the Committee. Joining me today are Dr. Mark
Koeniger, Acting Assistant Under Secretary for Health for Patient Care
Services, VHA, and Mr. Ken Smith, Executive Director, Education
Service, Veterans Benefits Administration (VBA). It is an honor to be
here on behalf of VA to discuss our progress on implementing the
Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits
Improvement Act (the Dole Act; P.L. 118-210).
Enacted on January 2, 2025, the Dole Act is a comprehensive law
with more than 70 sections that require action from VA, the Department
of Labor, educational institutions that serve Veterans and their
families, and the Government Accountability Office. The Dole Act
includes requirements for VA to:
implement more than 40 enhancements, new guidelines, or
new programs;
execute six new pilot programs;
conduct outreach and release new online tools for
Veterans, patients, and coroners/medical examiners; and
complete 50 new congressionally Mandated Reports.
This variety of new requirements required VA to realign its
priorities and establish an enterprise-wide approach to support Dole
Act implementation. This approach has been updated several times as new
VA leadership was sworn in and VA uses funding from multiple accounts
to deliver on some of the sections.
VA moved oversight of implementation of the Dole Act to the Office
of the Secretary to ensure senior official oversight and involvement in
these critical responsibilities. In December 2025, the new Office of
Strategic Initiatives became the office responsible for VA-wide
oversight, facilitation, and monitoring of implementation efforts, such
as those required by the Dole Act.
We are pleased to report that VA has made significant progress
toward implementing the Dole Act. Of the 72 sections that required VA
implementation efforts, VA has fully implemented 25 sections as of
February 9, 2026. We are diligently working on the remaining sections.
While implementation spans the Department, I will begin by
highlighting key accomplishments within VHA, which has led to
transformative changes in care delivery and support for Veterans and
their families under the Dole Act.
VHA
In alignment with section 101 of the Dole Act, effective May 19,
2025, VA eliminated an unnecessary layer of approval in the community
care process, allowing Veterans to access care when it is in their best
medical interest (BMI). Removing that unnecessary layer has made a real
difference. Between June and December 2025, referrals to community care
under the BMI criterion increased by over 66 percent compared to the
same period in the previous year. Additionally, VA launched a
nationwide outreach campaign, including updates to VA.gov and targeted
communications through the Solid Start program, reaching over 83,000
newly separated Veterans. These efforts help Veterans understand their
options for care from day one, creating a more seamless and responsive
health care experience.
The Dole Act also delivered expanded options for Veterans needing
long-term and home-based care. Using the authority granted by section
120 of the Dole Act, VA increased coverage for noninstitutional care
alternatives from 65 percent to 100 percent of nursing home costs, with
authority to exceed that cap for Veterans with amyotrophic lateral
sclerosis, spinal cord injuries, and similar conditions. This expansion
enables more Veterans to receive care at home, preserving independence
and dignity. These changes, combined with new pilot programs for
assisted living and enhanced Homemaker and Home Health Aide programs,
reflect VA's commitment to meeting Veterans where they are--with care
that honors their service and supports their families.
VA has also made critical strides in addressing homelessness and
suicide prevention under the Dole Act. Section 402 of the Dole Act
expanded per diem payments for homeless Veteran programs, increasing
the maximum per diem rate from 115 percent to 133 percent of the State
Home domiciliary rate and allows VA to waive the maximum rate for per
diem payments to provide payments at a rate that does not exceed 200
percent of the rates authorized for State Homes for domiciliary care
under 38 U.S.C. Sec. 1741(a)(1)(A) for no more than 50 percent of all
grant recipients and eligible entities for a Fiscal Year (FY), subject
to the availability of funding.
Section 403(a) of the Dole Act authorizes VA to provide to covered
Veterans, as VA determines necessary, food, shelter, clothing,
blankets, and hygiene items required for the safety and survival of the
Veteran; transportation required to support the stability and health of
the Veteran for appointments with service providers, the conduct of
housing and employment searches, and the obtainment of food and
supplies; and tablets, smartphones, disposable phones, and other
technology and related service plans required to support the stability
and health of the Veteran through the maintenance of contact with
service providers, prospective landlords, and family members. Section
403(b) authorized VA to collaborate with one or more organizations to
manage the use of VA land for homeless Veterans for living and
sleeping.
Section 404 created a new 38 U.S.C. Sec. 2069, which requires VA,
to the extent practicable, to ensure that Veterans participating in or
receiving services from a program under chapter 20 have access to
telehealth services to which the Veterans are eligible under the laws
administered by VA.
These changes, from implementing sections 402, 403 and 404,
strengthen the safety net for Veterans at risk of homelessness and
improve access to care. VA published a Federal Register Notice on
February 6, 2026, notifying the public of subregulatory guidance to
implement section 402 of the Dole Act, and we expect to publish very
soon a Federal Register Notice to inform the public about VA's
implementation of section 403 of the Dole Act.
In addition, section 149 of the Dole Act strengthened
accountability by requiring an independent assessment of the National
Veteran Suicide Prevention Annual Report and development of a public
toolkit for coroners and medical examiners to improve reporting
accuracy. The independent assessment was completed in January 2026.
VA's most recent Annual Suicide Prevention Report, published February
5, 2026, shows 6,398 Veteran suicides in 2023--down from 6,442 in
2022--with the average daily rate falling slightly to 17.5. However,
suicide rates remain elevated among younger Veterans and those facing
risk factors such as homelessness, health challenges, and chronic pain.
To address these risks, VA has expanded outreach and care access. Since
January 2026, VA has conducted a new outreach campaign that has led
more than 33,000 unenrolled Veterans to sign up for VA care, and
partnerships with civilian health systems have helped identify and
contact 140,000 at-risk Veterans. VA has made good progress on the
remaining requirements and anticipates meeting the statutory timelines.
VHA has experienced some challenges with implementation of certain
sections of the Dole Act, particularly section 143 (regarding
reimbursement for transporting certain Veterans by ambulance from rural
locations for care) and, to a lesser degree, section 129 (regarding
recognition of organizations and individuals to assist Veterans, family
members, and caregivers in navigating VHA programs and services). VA
would greatly welcome the opportunity to work with the Subcommittee to
modify these provisions to ensure VA can provide the benefits and
services intended by these sections.
VBA
These efforts within VHA demonstrate our commitment to improving
health care access and support for Veterans and caregivers. Equally
important are the provisions under the Dole Act that strengthen
Veterans' benefits and streamline claims processing.
Native Americans have historically served in the U.S. military at a
higher per capita rate than any other group. However, they face unique
challenges in obtaining home loans on Federal trust land. To help VA
address this challenge, the Dole Act expanded VA's Native American
Direct Loan (NADL) program, thereby strengthening VA's authority to
make, evaluate, and secure loans on trust land and giving Native
American Veterans more opportunities to purchase, build, improve, or
refinance homes on trust land. VA is also hiring additional NADL
coordinators and collaborating with other Federal agencies to develop
effective policies that support Native American Veterans and their
families and developing new policies to support a Native Community
Development Financial Institution relending program.
VA continues to prioritize systems enhancements to support
implementation of sections 208, 210, and 212 of the Dole Act. In 2025,
after years of planning and coordination, VA had scheduled and
committed to the decommissioning of the Benefits Delivery Network (BDN)
system. The Fiscal Year 2025 decommissioning date could not be moved
due to the ending of the BDN support contract in October 2025, and a
requirement to close out Fiscal Year 2025 books in BDN.
The largest provision of the Dole Act to be implemented by VBA is
section 212, which reestablished the Veterans Technology Education
Courses (VET TEC) program, or VET TEC 2.0. VA will implement the VET
TEC 2.0 claims processing capability in Fiscal Year 2026 and has made
other significant progress toward implementation. For example, on
December 16, 2025, VA published the Student Application in the Federal
Register, starting the 60-day public comment period. VA also
successfully completed updates to the payment management systems that
will enable Education Service to implement a claims adjudication and
process capability by the end of the third quarter of Fiscal Year 2026.
Finally, VA completed several other tasks to ensure a smooth rollout of
VET TEC 2.0 as soon as the information technology solution is
available. For example, VA completed:
the Training Provider application,
a draft Communications plan to notify the Training
Providers and begin soliciting and accepting new Training Provider
applications,
a Training Provider and Expert Credentials checklist, and
a training plan for the Training Providers and Education
Liaison Representatives.
VA has made progress toward implementing section 215 of the Dole
Act. For example, VA has linked the GI Bill Comparison Tool to the
Department of Education's (ED) College Navigator and recently met with
ED to identify the appropriate points of contact to incorporate
additional data.
VA will also schedule and adopt additional updates following two
recent court decisions - Rudisill v. McDonough and Perkins v. Collins.
Specifically, by 2027, VA will aim to achieve 1-day completion of
education claims and reinstitute VET TEC 2.0.
VA has not yet scheduled:
DGIB updates necessary to support the integration of the
new monthly housing allowance requirements under section 208; and
integration of electronic certificates of eligibility and
award letter requirements under section 210.
VA anticipates it will schedule these updates in 2026. To mitigate
challenges until they are scheduled, VA conducts quarterly reviews of
DGIB enhancements and continues to prioritize enhancements. VA will
continue to provide updates to Congress in our calls about DGIB
progress about sections 208 and 210.
In addition to benefits focused on the Native American community
and education services, the Dole Act strengthens memorial benefits
administered by the National Cemetery Administration. For example,
section 301 of the Dole Act expanded burial allowances for Veterans who
die at home while receiving VA hospice care, ensuring families receive
timely support during a difficult time.
National Cemetery Administration
VA is working under section 302 of the Dole Act to improve outreach
to States and tribal governments, helping ensure that Veterans and
their families are aware of burial and memorial benefits they have
earned. These provisions reflect VA's commitment to honoring Veterans
not only throughout their lives but also at life's end, with dignity
and respect.
Conclusion
Chairwoman Kiggans and Ranking Member Ramirez, this concludes my
statement. We appreciate the opportunity to speak before you today and
welcome any questions you or other Members of the Subcommittee may
have. Thank you for your continued support of Veterans, their families,
caregivers, and survivors as well as the many VA programs to support
them.
Prepared Statement of Sharon Silas
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Statements for the Record
----------
Prepared Statement of Elizabeth Dole Foundation
Chairwoman Kiggans, Ranking Member Ramirez, and members of the
subcommittee, the Elizabeth Dole Foundation would like to thank you for
the opportunity to submit our views on the status of implementation of
the Senator Elizabeth Dole 21st Century Veterans Healthcare and
Benefits Improvement Act.
The passage of this legislation during the 118th Congress marked
one of the most significant Federal policy advancements secured on
behalf of veterans, caregivers, and survivors in recent years, and
Senator Dole remains both proud and humbled to have had it named in her
honor.
The Foundation worked tirelessly with caregivers and our veteran
service organization partners to secure its passage not only because of
the impact on family caregivers, but also because of the broad array of
issues covered in the bill that impact veterans and families. While as
an organization we focus on issues of direct impact to caregivers, we
also address issues of significant interest to that population.
Clearly, the quality of the care and services available to veterans is
at the top of that list.
Daily we hear from caregivers asking about the long-delayed
finalization of the rule governing the Department of Veterans Affairs
Program of Comprehensive Assistance for Family Caregivers (PCAFC). We
are now entering year 4 of waiting for a new rule to expand eligibility
and improve the program. Even more often, however, we hear from
caregivers about their struggles navigating VA's programs and services
including Veteran Directed Care, CHAMPVA, respite, home health, skilled
care, benefits, home and vehicle modifications, etc.--all programs
intended for the veteran but with real life impacts for the whole
family.
While there is still work to be done, the Dole Act was intended to
address many of these challenges for the benefit of the entire veteran
community. We are especially pleased that Section 120, which
drastically increased the expenditure cap for non-institutional care,
was implemented in September 2025. The enactment of this provision
helps our most vulnerable veterans and their caregivers by removing a
long-standing barrier to keeping loved ones at home. We encourage VA
and the Office of Geriatric and Extended Care (GEC) to continue
training clinical providers and social workers both inside and outside
GEC on this opportunity to ensure those in need are aware of available
services.
However, the Elizabeth Dole Foundation has questions and concerns
regarding multiple remaining provisions and their current status.
Section 101:
Section 101, also known as the ``Medical Best Interest'' provision,
allows veterans to access care in the community if it is determined by
the clinician that it is in the veteran's medical best interest to do
so. We supported this provision because we recognize both the need to
ensure VA is able to offer robust, high-quality care as well as provide
access to necessary care in a timely manner, sometimes found in the
community. We are familiar with cases where this provision was
especially helpful in getting a veteran to appropriate specialty care.
However, VA's regulations that govern necessary travel often associated
with care in the community have not yet caught up to the intent of
section 101.
Under the current rules, VA can only authorize travel reimbursement
to the closest medical facility that can provide the necessary care.
Since the relevant provision does not comment on the facility's
capability--only on the veteran's medical best interest--we are seeing
travel authorizations denied even though the care itself is authorized.
We encourage VA to reconcile this language to ensure that veterans and
their family members are not unnecessarily and unintentionally caught
in a bureaucratic trap that leads to either increased out-of-pocket
expenses or an inability to access care.
Section 122:
Based on the Chairwoman's COPE Act, this provision authorizes the
VA Secretary to award grants to community-based organizations to
provide mental health services to family caregivers participating in
PCAFC. According to a 2024 RAND study commissioned by the Elizabeth
Dole Foundation, caregiving often places significant strain on
caregivers and increases their risk for developing physical and mental
health conditions, including depression and suicidal ideation.
Relatedly, caregivers' mental well-being directly affects the quality
of care provided, impacting outcomes for both caregivers and those they
support. By prioritizing the mental health of caregivers, the overall
effectiveness of care can be enhanced.
Recognizing both the value and risks associated with caregiving, VA
established a program through which PCAFC caregivers can receive mental
health care from VA providers, with options available through both
telehealth and in person. With approximately 29,000 encounters among
4,374 patients in Fiscal Year 2025, the program is certainly beneficial
and a significant step in the right direction. However, caregivers
enrolled in PCAFC are often hesitant to seek mental health services
directly from VA for fear their participation will impact their
eligibility for the caregiver support program. In addition, they are
hesitant to use another VA program, as it is perceived as an additional
care coordination burden.
While VA has not yet issued grants in accordance with section 122,
as it was discretionary and not mandatory, the Elizabeth Dole
Foundation strongly supports the establishment and issuance of these
grants to increase opportunities for access to necessary mental health
care for family caregivers. In addition, the Elizabeth Dole Foundation
supports increasing the pool of eligible participants to those enrolled
in the VA's Program of General Caregiver Support Services (PGCSS),
rather than just PCAFC, to improve the health and well-being of a
larger pool of caregivers as well as that of the veterans for whom they
care.
Section 123:
Derived from the original Elizabeth Dole Home Care Act introduced
by Representatives Brownley and Bergman, Section 123 codifies the Home
and Community Based Services (HCBS) programs to ensure their long-term
viability. Under this provision, the Veteran Directed Care (VDC)
program, provided in partnership with the Administration on Community
Living (ACL), is required to be provided at each VA medical center. VDC
provides a flexible, monthly budget, allowing veterans to hire their
own caregivers---- including family or friends--and purchase services
to manage their care. This system offers more control and ownership of
that care to the veteran and caregiver and, where utilized, has proven
very effective.
VA has stated that VDC is now technically available in all VA
medical centers, but we have learned that access remains difficult due
to a limited number of contracts in place, staffing VDC as a collateral
duty, and a general lack of knowledge of program availability. In order
to learn what steps may have been made to address some of these
challenges, the Elizabeth Dole Foundation requests VA brief all
interested veteran service organizations regarding the current status
of VDC implementation including enrollment numbers and locations,
current contract availability, and staffing models. This briefing will
help VA identify ongoing challenges as they seek the full
implementation of this valuable program.
Sections 123 and 124:
The Elizabeth Dole Foundation was pleased to participate in a
recent roundtable hosted by the Senate Veterans Affairs Committee to
discuss many of the improvements to PCAFC required under sections 123
and 124. These include the enhanced use of automation to facilitate
information gathering and eligibility determination processes as well
as improvements to decision letters to better inform applicants. The
Elizabeth Dole Foundation was also pleased to learn that steps are
being taken to improve the coordination of care between the PCAFC
program and services available to individuals under GEC.
While we appreciate these positive steps, the Elizabeth Dole
Foundation is gravely concerned that the final rule governing the PCAFC
program has not been issued. As mentioned above, recognizing
significant challenges and an excessive number of caregiver removals in
March 2022, the VA suspended discharges from the program in an effort
to pause, review, and discuss needed changes. Eventually, VA entered
into a new rulemaking process and issued a proposed rule in December
2024. Garnering over 800 comments, this proposed rule appears to be
stalled; we are now well over a year after its issuance, leaving this
highly vulnerable population of family caregivers in limbo as they wait
to learn their fate. Worse, the very rule that was recognized as
insufficient in 2022 and that resulted in the pause, is still being
used today to determine eligibility for new applicants, leaving many
out of the program whom Congress intended to cover. The Elizabeth Dole
Foundation strongly urges Congress to use its oversight authority to
impress upon VA the urgency of finalizing a rule quickly that supports
family caregivers and aligns with congressional intent.
Section 129:
Commonly referred to the ``Pathway to Advocacy'' this provision
requires the VA Secretary to establish a process by which organizations
can become trained, certified and recognized to help a veteran,
caregiver, or survivor to navigate the services of the Veterans Health
Administration. Too often, this committee learns of situations where
vulnerable individual veterans or their family members are unaware of
or unable to access the programs intended to help them, even though VA
has the services necessary to support them. Given the potential
positive impacts of this initiative on connecting veterans, caregivers,
and survivors with needed resources, the Elizabeth Dole Foundation
again recommends that VA brief interested organizations on the status
of this provision's enactment and solicit feedback to ensure any
recommendations align with congressional intent.
Section 130:
Given veteran preference for care in the home, GEC provides an
invaluable set of tools to both accommodate the veteran's wishes and
support the family caregivers who are often thrust into this role.
Among other things, section 130 requires that VA undergo an extensive
review of these services to ensure consistency in program management,
appropriate staffing levels, proper care coordination, and eliminate
service gaps. While this provision was enacted prior to the current
reorganization efforts underway at the agency, the Elizabeth Dole
Foundation encourages VA to enact the provisions in the spirit in which
they were intended to ensure that these vital programs are staffed
appropriately to better serve veterans and caregivers.
Conclusion:
The passage of the Senator Elizabeth Dole 21st Century Veterans
Healthcare and Benefits Improvement Act provided an opportunity for VA
to implement bipartisan legislation that was carefully crafted with the
support of many in the veteran community. As VA continues its work on
the implementation of this law, we encourage the agency to update and
solicit regular feedback of relevant veteran service and non-profit
organizations to achieve our mutual goal of serving veterans,
caregivers, and survivors.
The Elizabeth Dole Foundation would once again like to thank the
subcommittee for the opportunity to present our views today. We look
forward to continuing to work with you on the full and prompt
implementation of this law and would be happy to answer any questions.
[all]