[House Hearing, 119 Congress]
[From the U.S. Government Publishing Office]
PUTTING FAMILIES FIRST:
STRENGTHENING CHAMPVA FOR
SURVIVORS AND DEPENDENTS
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HEARING
BEFORE THE
SUBCOMMITTEE ON HEALTH
OF THE
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED NINETEENTH CONGRESS
FIRST SESSION
__________
WEDNESDAY, DECEMBER 10, 2025
__________
Serial No. 119-39
__________
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
63-814 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 HEALTH
MARIANNETTE MILLER-MEEKS, Iowa, Chairwoman
JACK BERGMAN, Michigan JULIA BROWNLEY, California,
GREGORY F. MURPHY, North Carolina Ranking Member
DERRICK VAN ORDEN, Wisconsin SHEILA CHERFILUS-MCCORMICK,
JEN KIGGANS, Virginia Florida
ABE HAMADEH, Arizona MAXINE DEXTER, Oregon
KIMBERLYN KING-HINDS, Northern HERB CONAWAY, New Jersey
Mariana Islands KELLY MORRISON, Minnesota
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, DECEMBER 10, 2025
Page
OPENING STATEMENTS
The Honorable Mariannette Miller-Meeks, Chairwoman............... 1
The Honorable Julia Brownley, Ranking Member..................... 3
WITNESSES
Panel I
Dr. Maria Llorente, MD, Acting Assistant Under Secretary for
Health, Office of Integrated Veteran Care, U.S. Department of
Veterans Affairs............................................... 5
Accompanied by:
Mr. David Fennell, Director, Veteran and Family Member
Programs, Integrated External Networks, Office of
Integrated Veteran Care, U.S. Department of Veterans
Affairs
Mrs. Caira Benson, Veteran Support & Strategic Initiatives
Specialist, Code of Support Foundation......................... 6
Mr. James Zenner, National Policy Director, National Association
of County Veteran Service Officers............................. 8
APPENDIX
Prepared Statements Of Witnesses
Dr. Maria Llorente, MD Prepared Statement........................ 25
Mrs. Caira Benson Prepared Statement............................. 26
Mr. James Zenner Prepared Statement.............................. 28
Statements For The Record
Questions for the Record Submitted by The Honorable Marianette
Miller-Meeks, U.S. House of Representatives, (IA-01)........... 31
Response to Questions for the Record Submitted by Caira Benson... 36
Response to Questions for the Record Submitted by U.S. Department
of Veterans Affairs............................................ 39
Response to Questions for the Record Submitted by National
Association of County Veterans Service Officers................ 49
Paralyzed Veterans of America Prepared Statement................. 56
PUTTING FAMILIES FIRST:
STRENGTHENING CHAMPVA FOR
SURVIVORS AND DEPENDENTS
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WEDNESDAY, DECEMBER 10, 2025
Subcommittee on Health,
Committee on Veterans' Affairs,
U.S. House of Representatives,
Washington, DC.
The subcommittee met, pursuant to notice, at 3:38 p.m., in
room 360, Cannon House Office Building, Hon. Mariannette
Miller-Meek [chairwoman of the subcommittee] presiding.
Present: Representatives Miller-Meek, King-Hinds, Kiggans,
Brownley, Cherfilus-McCormick, Dexter, and Conaway.
OPENING STATEMENT OF MARIANNETTE MILLER-MEEKS, CHAIRWOMAN
Ms. Miller-Meeks. The Subcommittee on Health will now come
to order. The chair may declare recess at any point. That was
when we were anticipating votes.
I would like to welcome all the members and the witnesses
to today's hearing. Many here today have likely heard that the
U.S. Department of Veterans Affairs (VA) has taken significant
steps to improve the Civilian Health and Medical Program of the
Department of Veterans Affairs, CHAMPVA. CHAMPVA is a program
to provide earned benefits for veterans' families whenever the
veteran has qualifying service-connected disabilities or death.
A veteran spouse or child can access a range of covered health
services through CHAMPVA, inpatient and outpatient care,
prescription drugs, mental health services, skilled nursing
care, and others.
CHAMPVA is a way that we honor our commitment to serving
the veterans and their families who are injured in the line of
duty. Sometimes circumstances require that family members
forego a full-time job with health insurance benefits so they
can care for their veteran full time instead. These caregivers
consider CHAMPVA a lifeline.
Decades ago, Congress created CHAMPVA to close a gap left
by TRICARE. CHAMPVA, when it works, is a huge relief for
veterans and their families. Affordability is on everyone's
mind and that is especially true for veteran families with
serious medical needs. Fortunately, the VA has recently taken
steps to ensure CHAMPVA works. I am pleased that the Trump
administration is pulling out all the stops to bring down the
cost of living by putting families first.
Just before Thanksgiving, Secretary Collins announced the
elimination of CHAMPVA application backlog. That is over 60,000
more families who can now access caregiver healthcare benefits
at the VA.
The subcommittee appreciates the VA's work to modernize
CHAMPVA. Online applications and claims should have been
available a long time ago, but if we continue to hold the VA
accountable, veterans and their families will see greater
results.
As a case in point, I am particularly pleased that the VA
is in the process of developing a CHAMPVA Provider Directory.
This is after an abundance of feedback from Members of Congress
to the VA about the difficulty that beneficiaries have even
finding someone who will accept CHAMPVA. The committee has been
diligent in exploring solutions for a provider directory. I
want to thank my friend and colleague, Oversight Committee
Chairwoman Jen Kiggins for her leadership on this issue as she
recently wrote a letter and introduced legislation to create
this system for veterans and their families. Needless to say,
we will continue to exercise oversight to ensure that the
CHAMPVA Directory is fully implemented.
Modernization like this and CHAMPVA's ongoing efforts
enhances the convenience of using the CHAMPVA program, and now
VA can process applications and claims faster than they have in
the past. I am encouraged that the VA is now aiming to process
100 percent of electronic claims within 30 days. It should be
noted that in the past, their stretch goal was to process 90
percent of electronic claims in that time.
However, there are still obstacles and opportunities for
this program. Navigating VA bureaucracy is never easy. I have
heard that certain obstacles remain in CHAMPVA, and I expect
our witnesses to highlight these issues today.
Foremost, this subcommittee will do its part so that the VA
can process 100 percent of all claims within 30 days, not only
the electronic ones. Paper claims still take too long to
process. I know delays are inherent and manual processing is
tedious, but I look forward to working with the VA to speed up
paper processing as well.
Second, there is limited transparency for status updates on
applications or claims requests. Spouses and children want to
know what is going on with your application. Caregivers and
providers want to know whether their claims will be accepted or
denied. Whenever they hear radio silence from the VA, they lose
trust in the VA.
This subcommittee spoke with one large healthcare provider
who shared that the VA assigned a direct representative to
address their claims questions. The direct representative was
too overwhelmed to ever timely resolve the provider's
questions. The provider would have to wait months just to get
questions answered. Speaking as a veteran and a provider, I
want to ensure this provider's experience is a thing of the
past. There must be a better way to get information for
families and providers so they know exactly what their benefits
are ahead of time.
Third, the VA could resolve claims faster if it improved
its ability to cross-reference a spouse or a child's health
insurance and whether that person reached his or her
deductible. Because CHAMPVA can function as either a primary or
a secondary payer, providers must properly bill either the
program or somebody else's health insurance first.
Unfortunately, this coordination frequently breaks down and
providers lose time filing the claim, only for the VA to
require a different form.
It is also important to know in real-time whether a spouse
or child has reached the deductible. Right now, real-time
knowledge is unavailable to claims processors. I would like to
see that change.
Last, some aspects of the CHAMPVA process create snags for
caregivers that limit the program's use. The subcommittee has
heard most about the fact that CHAMPVA identification cards
are, in fact, not cards. They are strips of paper. Mrs. Benson
so clearly explained the issue when she showed this
subcommittee her own card. She explained that if anything
happens to the card, meaning paper strip, like if somebody
accidentally spills a drink on it, it has never happened to
anybody in this committee or in the audience, the caregiver
must wait for another strip of paper from the VA. Caregivers
should not have to ask their neighbor for a laminator to avoid
damage or destruction to their healthcare paperwork.
I hope this discussion sheds light on these concerns and
opens the door to further discussions on how we continue to
modernize CHAMPVA and have it work better for veterans and
their caregivers.
Just like every other American family, veteran families
with caregiving responsibilities set aside this time of year to
give their thanks to God, celebrate one another, and enjoy
tradition. Caregivers must also balance the healthcare demands
to ensure that they and their loved ones in need enjoy the
season to the fullest. Our goal with this hearing is to make
CHAMPVA work as it is intended to serve veterans families.
Finally, I would like to thank beneficiaries, like Mrs.
Benson and many others from groups like Senator Elizabeth
Dole's foundation, for sharing their stories and bringing
CHAMPVA's issues to us.
I now yield to Ranking Member Brownley for any open remarks
she may have.
OPENING STATEMENT OF JULIA BROWNLEY, RANKING MEMBER
Ms. Brownley. Thank you, Madame Chair. Thank you to our
witnesses for being here today and apologize for the waiting
that you had to undergo. I am glad to have an opportunity to
examine the CHAMPVA program and the significant opportunities
for improvement in VA's administration of this program.
I would first like to note that the committee staff have
not received a briefing from VA's Office of Integrated Veteran
Care (IVC) since December 2024, a whole year ago. I hope you
agree, Madame Chair, that this is wildly unacceptable,
especially considering this office is responsible for
administering community care programs that account for more
than $40 billion per year in VA expenditures. Committee staff
used to receive briefings from this office every other month. I
am very concerned that under the Trump administration, these
briefings have completely stopped.
CHAMPVA is just one of the programs the Office of
Integrated Veteran Care administers, and it is my understanding
that they were working on a number of initiatives to improve
this program throughout 2024, but we have received no updates
in nearly a year.
I am glad VA officials are here today to share their recent
progress, but it is clear from our other witnesses' testimony
that far more remains to be done and we need more regular
oversight of CHAMPVA program. Whether it is the lack of online
self-service tools for applicants, enrollees, and providers,
the lack of a formal provider network or online provider
directory, or the lack of transparency for beneficiaries and
providers about allowable payment rates, there are many ways
that CHAMPVA could work better for beneficiaries and providers.
As many of you know, I have long been a proponent of
reforms for CHAMPVA. I strongly believe my legislation to allow
dependents to remain enrolled until they turn 26, regardless of
school enrollment, is necessary to ensure parity between
CHAMPVA and most Other Health Insurance (OHI) plans. However,
in previous testimony about my CHAMPVA bill, VA indicated that
it does not view CHAMPVA as an insurance plan, but as a medical
care benefit. As I said, then, if it walks like a duck and
swims like a duck and quacks like a duck, it is probably a
duck. CHAMPVA has copays, annual deductibles, and maximum out-
of-pocket costs. It has a formulary. CHAMPVA requires prior
authorization for certain services. It counts as minimum
essential coverage under the Affordable Care Act (ACA). If that
is not health insurance, I do not know what it is.
VA needs to decide if it wants to continue to force
caregivers and families of veterans to navigate a system that
has all of the complexities and frustrations of health
insurance and places all the burden of navigating that system
on beneficiaries, or if it wants to provide the loved ones of
fallen and severely injured servicemembers and their caregivers
of our most vulnerable veterans with the best support and
healthcare benefits possible. That is my choice.
Mrs. Benson, I am glad we have you here today to speak
about your own experiences as well as your work with the Code
of Support Foundation, helping other families and caregivers
navigate the system. It is clear from your testimony that you
are well-versed in this program and how to navigate it. VA
should not be reliant on beneficiaries to recruit providers,
determine what codes will allow VA to process claims, and know
every step of a complex appeals process. The way the system is
currently set up, it seems you need endless hours of free time
and the equivalent of a Ph.D. in health insurance just to make
sure your family can get covered for the care you need. This
obviously is not acceptable.
I believe it is clear to everyone in this room that there
is massive room for improvement in the CHAMPVA program. This
hearing is a good step at providing insight and oversight. I
hope it will not end here.
I thank you and, Madame Chair, thank you for the hearing,
and I yield back.
Ms. Miller-Meeks. Thank you, Ranking Member Brownley.
I would now like to introduce our witnesses who have been
very patient through this process. Thank you again.
Testifying before us today, we have Dr. Maria Llorente,
acting assistant under secretary for health at the Office of
Integrated Veteran Care at the VA. She is supported by Mr.
David Fennell, director of veteran and family member programs,
including CHAMPVA. Mrs. Caira Benson, veteran support and
strategic initiatives specialist at the Code of Support
Foundation. She is also a CHAMPVA beneficiary. Mr. Jim Zenner,
excuse me, national policy director for the National
Association of County Veteran Service Officers.
Dr. Llorente, you are now recognized for 5 minutes to
present your testimony.
STATEMENT OF MARIA LLORENTE
Dr. Llorente. Thank you. Chairwoman Miller-Meeks, Ranking
Member Brownley, and distinguished members of the subcommittee,
thank you for the opportunity to testify today about the
Civilian and Medical Program of the Department of Veterans
Affairs, or CHAMPVA, a vital program that provides healthcare
coverage to eligible spouses, children, survivors, and
caregivers of qualifying veterans. Joining me today is Mr.
David Fennell. He is the director of veteran and family member
programs in the Office of Integrated Veteran Care.
CHAMPVA plays a critical role in supporting the families of
veterans who have made profound sacrifices in service to our
Nation. My testimony today will provide an overview of the
program's eligibility criteria, current operations, recent
improvements, and opportunities for continued collaboration
with Congress to ensure timely, efficient, and equitable access
to care. Authorized under the United States Code Title 38,
Section 1781, CHAMPVA provides healthcare coverage to eligible
spouses, surviving spouses, and children of veterans who are
permanently and totally disabled due to a service-connected
disability or who died as a result of a service-connected
condition or who died while rated permanently and totally
disabled from a service-connected condition. It also covers
certain survivors of members who died in the line of duty and
certain primary family caregivers under the program of
Comprehensive Assistance for Family Caregivers.
To be eligible for CHAMPVA, the individual cannot be
eligible for TRICARE. As of November 2025, CHAMPVA provides
healthcare coverage to more than a million beneficiaries. The
program receives approximately 4,000 new applications every
week, and more than 90 percent of medical and pharmacy claims
are now processed electronically within days of receipt,
ensuring timely reimbursement and continuity of care.
Under the leadership of Secretary Collins, and thanks to
recent reforms, the application backlog, previously exceeding
70,000 cases, has been eliminated. New applications are now
processed in a matter of days. The appeals backlog has also
been reduced from over 20,000 to approximately 1,000 with
continued progress underway. These improvements reflect
Department of Veterans Affairs' commitment to veteran first
service delivery, accountability, and efficiency.
Under the last administration, CHAMPVA faced significant
delays in application and appeals processing due to increased
demand, staffing constraints, and reliance on legacy manual
systems. Some applicants waited over 150 days for
determinations. Under Secretary Collins' leadership, VA
implemented a two-pronged strategy: authorizing overtime for
application processors and introducing enhanced process
engineering and new automation to streamline workflows. These
actions have assured timely access to benefits for eligible
CHAMPVA beneficiaries.
VA is modernizing CHAMPVA operations to reduce bureaucracy
and improve the user experience. In December 2025, we will
complete the transition to a more automated application
processing system, increasing efficiency and reducing manual
workload. These efforts align with VA's broader digital
transformation strategies and support the Department's goals of
transparency, reduced administrative burden, and improved
outcomes for veterans and beneficiaries.
Access to accurate provider information is another area of
focus. Although CHAMPVA beneficiaries may see any provider who
accepts CHAMPVA's allowable rates, VA acknowledges that
beneficiaries may experience difficulty identifying
participating providers or confirming whether a provider is
accepting new patients. We are working to improve how provider
information is presented and maintained, including updating
publicly available guidance and strengthening communication
with providers who build CHAMPVA.
We appreciate the continued interest in strengthening
CHAMPVA. Over the last few months, VA has made significant
strides in eliminating backlogs, modernizing systems, and
improving access. We remain focused on delivering timely, high-
quality service to those who have sacrificed so much.
This concludes my statement and we look forward to
responding to any questions that you may have.
[The Prepared Statement Of Maria Llorente Appears In The
Appendix]
Ms. Miller-Meeks. Thank you, Dr. Llorente.
Mrs. Benson, you are now recognized for 5 minutes to
present your testimony.
STATEMENT OF CAIRA BENSON
Mrs. Benson. Chairwoman Miller-Meeks, Ranking Member
Brownley, and members of the House Veterans' Affairs
Subcommittee on Health, thank you for inviting me to testify
today. It is my honor to return to further the discussion on
the inefficiencies and inequalities within the Department of
Veterans Affairs CHAMPVA Program.
At the Code of Support Foundation we work with veterans and
their families every day. Our digital resource hub,
PATRIOTlink, has served over 67,000 military community members
to find needed supports and resources. Our case management team
has already worked with over 1,300 family members this year to
navigate local, regional, national, and government partners to
achieve stability through needed financial, social, physical
health, and mental health supports. I am not just here as an
employee. I am here as a caregiver and advocate and Elizabeth
Dole Foundation fellow alum and a CHAMPVA user.
I care for my husband, who deployed twice to Iraq as a
combat engineer between 2003 and 2006. My husband suffered
multiple traumatic brain injuries during his years of service,
complicated by toxic encephalopathic process, most likely due
to chemical exposure. My five children and I enrolled in
CHAMPVA in 2017, when my husband was awarded permanent total
status for service-connected injuries. We breathed a sigh of
relief knowing that we would have the safety net of healthcare
for myself and our children, three of whom have needed
specialty medical care through the years.
I testified in June of this year to this subcommittee about
the nightmare navigating CHAMPVA has been for our family.
Highlights of that nightmare include having to sign a $110,000
promissory note to ensure a needed hospitalization occurred in
the chance that CHAMPVA refused payment and being sent to
collections when CHAMPVA claims payments did not occur in a
timely manner, with one provider waiting over 27 months for
payment. CHAMPVA's appropriate care has felt anything but
appropriate.
I will not rehash my earlier testimony. I know the
committee is interested in how the situation looks for CHAMPVA
today, if changes have been made, and how those changes have
been received since my last testimony.
I commend VA for finally clearing the CHAMPVA application
backlog. It is beyond time to process applications in real
time.
I was also overjoyed to hear that claims being submitted
electronically are being paid quicker than previously. Yet even
with that good news, the situation on the ground for CHAMPVA
users remains murky. While the application backlog is cleared,
only two families I know waiting on their decisions have
received notifications of such to date.
Provider acceptance of CHAMPVA still remains a challenge. I
had a medical complication this year which required me to
travel over an hour for outpatient procedures as they were the
nearest willing provider to file. I still pay out of pocket for
my children's mental health providers as we have yet to find a
provider who accepts CHAMPVA mental health for kids.
I know I am not alone. At Code of Support one of our most
frequent requests is mental health supports for dependents. We
have multiple national and regional providers we work with for
those supports. Five take TRICARE and refuse to take CHAMPVA.
To quote one, VA is too difficult to work with.
It is hard to place blame on the providers for declining
CHAMPVA . Indeed, VA has made it difficult on providers filing
claims and on users looking for providers. Lack of a provider
network and published fee schedules, unclear claims filing
processes, and varied claims payment times contribute to the
difficulties. Appeals for denied coverage under CHAMPVA are
difficult to navigate as well.
A CHAMPVA enrollee recently had her child's claim for an
ambulance ride during an anaphylaxis event denied. It took us
an hour of digging through claims denial letters, Explanation
of Benefits (EOB), and Current Procedural Terminology (CPT)
codes to understand what had happened. The denial was due to
inaccurate billing codes. While we do not believe the CHAMPVA
enrollee will be charged for the ambulance ride, the denial
letter listed three appellate structures, none of them the
Clinical Appeal option listed on the CHAMPVA website. None of
them offered an option for a third party review, something that
was considered routine in today's world of denied insurance
claims.
As they did in the Senate Veterans Affairs Committee on May
21, 2025, VA has argued in the past that CHAMPVA is not an
insurance product, it is a medical service. I remain steadfast.
The industry, the Federal Government, and, more often than not,
VA itself treats CHAMPVA as an insurance product. If we choose
to shop for insurance through Healthcare Marketplace, CHAMPVA
enrollees are not eligible for financial assistance nor
advanced premium tax credits.
Every year, CHAMPVA enrollees receive a 1095B attesting to
the fact that CHAMPVA accounts for minimal essential coverage
under the Affordable Care Act. Finally, even VA states that
CHAMPVA is only available to caregivers in the VA's Program for
Comprehensive Assistance to Family Caregivers when they have no
other health insurance. Thus, CHAMPVA identifies itself as an
insurance plan when it offers proof of coverage and bars use of
its plans in the face of other coverage.
Indeed, the stance that CHAMPVA is not an insurance product
is detrimental to veterans families. At Codes of Support I
recently walked a disabled veteran through enrollment for his
wife into CHAMPVA. Prior to reaching out to us, the veteran had
purchased insurance for his dependent, causing a financial
burden through the Healthcare Marketplace, not understanding
that CHAMPVA provided ACA compliant coverage.
In short, CHAMPVA remains a complicated mess for users.
While VA has announced positive steps to easing some of these
known problems, CHAMPVA fixes are far from complete. CHAMPVA
users need statutory change and regulatory clarity, mandated
electronic claims filings, and claims--and clarity in claims
appeals processes, including a third party review.
In VA's mission to fulfill President Lincoln's promise to
care for those who have served for our Nation's military and
for their families, caregivers, and survivors, CHAMPVA is
failing. As a community we cannot continue to allow this
egregious lapse of coverage for those who need it most.
I thank you for your time and I look forward to your
questions.
[The Prepared Statement Of Caira Benson Appears In The
Appendix]
Ms. Miller-Meeks. Thank you, Mrs. Benson.
I now recognize Mr. Zenner for his opening testimony for 5
minutes.
STATEMENT OF JAMES ZENNER
Mr. Zenner. Chairwoman Miller-Meeks and Ranking Member
Brownley, distinguished members of the committee, thank you for
the opportunity to appear before you today on behalf of the
National Association of County Veteran Service Officers. N-A-C-
V-S-O or NAC-V-S-O represents the government-employed
accredited advocates who help veterans and their families
access the benefits that they have earned.
First, I want to express our sincere appreciation to the
CHAMPVA staff for their extraordinary progress in reducing the
application backlog. We are hearing reports of applications
being processed on average of 10 days and in some as few as 4.
That is not simply an administrative improvement, it is timely
access to healthcare for eligible dependents and we thank the
teams responsible for this achievement.
Today I want to highlight several practical refinements
that would increase accessibility and efficiency for CHAMPVA
families and the Government Veteran Service Officers (GVSO) who
serve them. Our first recommendation is modernizing the CHAMPVA
application process. Right now, GVSOs cannot submit CHAMPVA
applications electronically. They must print, complete, and
then fax or mail them, which prevents confirmation of receipt,
prevents tracking, and makes it difficult to provide updates to
families.
Meanwhile, many dependents cannot use VA.gov. The digital
submission workflow similar to the Veterans Benefits
Administration's (VBA) National Work Queue would allow
electronic submission, real-time status updates, and reduce
burden on CHAMPVA staff. Additionally, expanding the VA Form
21-22 authority to include Veterans Health Administration (VHA)
and CHAMPVA would allow accredited officers to communicate with
CHAMPVA staff directly, speeding resolution of issues for
families.
Our second recommendation is expanding provider awareness
and participation. Across the country many community providers
do not know what CHAMPVA is, who it covers, and how the billing
works. Some confuse it with TRICARE or VA Community Care, and
this creates avoidable access barriers. Targeted education
campaigns, provider toolkits, inclusion and electronic billing
systems, and partnerships with medical associations would
meaningfully expand access for spouses, dependents, and
caregivers.
Third, we recommend redesigning CHAMPVA identification
cards. Providers frequently mistake the CHAMPVA card for the
Community Care card and, in some cases, dependents have been
turned away. A distinct and easily recognizable card would
reduce confusion and improve the care experience.
Finally, we urge the committee to address the coverage gap
for dependent students turning 18. Under current policy,
CHAMPVA eligibility elapses until school enrollment is
verified, a process that often takes 8 to 9 months. During this
time, dependents incur medical costs out of pocket, claims are
lost or forgotten, and families face unnecessary stress despite
the fact that VBA has already determined the underlying
eligibility. Provisional continued coverage, automated
verification with schools, online certification at VA.gov and
pre-verification notices would significantly reduce this
burden.
CHAMPVA is a very strong program and recent progress
demonstrates VA commitment to families of those who have
served, but continued refinement is both necessary and
achievable. Government Veterans Service Officers stand ready to
assist VA and this committee in improving processes, expanding
access, and ensuring that eligible family members receive
timely, reliable health coverage.
Thank you for your leadership and thank you for the
opportunity to testify today. I am happy to answer any
questions. Thank you.
[The Prepared Statement Of James Zenner Appears In The
Appendix]
Ms. Miller-Meeks. Thank you very much, Mr. Zenner.
As is my typical practice, I will reserve my time until all
of the members have had a chance to ask their questions.
I now recognize Ranking Member Brownley for 5 minutes for
any questions she may have.
Ms. Brownley. Thank you, Madame Chair.
My first question is to Ms. Llorente. Thank you for being
here. We know based on Mrs. Benson's testimony that even
despite VA's recent elimination of the application backlog, and
that is a good first step, I want to acknowledge that, that is
a good first step, but many families are still waiting to know
the status of their applications and their school enrollment
certifications. The only way for them, the way I understand it,
is to check their status is to call the call center, the
CHAMPVA call center. Do you know what the average wait time is
to talk to someone on the other end of the call center?
Dr. Llorente. Yes, ma'am. Thank you. It can vary based on
the time of day, the day of week. In some cases, it could be as
little as 5 to 10 minutes. In other cases, it could be as long
as several hours.
Ms. Brownley. As long as how many?
Dr. Llorente. Several hours.
Ms. Brownley. Several hours.
Dr. Llorente. Yes. We do have a callback feature that is
part of the call center, but it is not acceptable.
Ms. Brownley. Well, I know the committee staff called the
service line four times and all four times there was a message
saying that the wait time would be over 2 hours. Not 2 hours,
but over 2 hours. Why--I mean, that seems like an easy problem
to solve and I do not know why it is not being solved.
I mean, it is great to, you know, attack the backlog. That
is great. If people cannot get finality to the situation, that
is not great. This, you know, waiting more than 2 hours for
folks can be pretty frustrating.
Dr. Llorente. Yes, ma'am, I agree with you. We are taking a
series of steps in order to address the issue. I wish that it
was an easy problem to solve because please be assured, if it
was, it would have been solved.
Some of the various steps that we are in the process of
taking are looking at our workflows, standardizing some of the
workflows. We have also begun leveraging additional contractor
support. We do have a contractor with whom we work that assists
in surging and answering the call center.
A very important step that we are working on conducting is
being able to do online status verification so that there would
not even be a need for, for a phone call. The veteran and/or
the beneficiary would be able to check online and be able to
see the status of their application, the status of their claim.
We are planning to be able to do that in 2026. Efforts are
underway. These are some of the steps that we are taking.
Ms. Brownley. Okay. Until that program happens, if somebody
is waiting over 2 hours to talk to a live human being, their
issue has not been resolved, then do they just have to say
thank you very much and try next week and go through the same
exercise, or do you prioritize that person and call them back
with a resolution to what the issue is so that they do not have
to continually go through this horrendous process?
Dr. Llorente. Yes, that is one of the features that are
part of our call centers. We are able to call the veteran and/
or the beneficiary back.
Ms. Brownley. Okay. Mrs. Benson, so, again, thank you for
being here. You have been quite helpful to us looking into this
process, so really appreciate your time and focus on this.
In your testimony, you discussed how difficult it has been
to find pediatricians and mental healthcare providers willing
to accept the CHAMPVA payment. I know you talked about, you
know, having a list of a network of providers, you know, that
you can reference somehow. I do not think that that is going to
happen overnight. We are still arguing with the VA whether this
is an insurance policy or not. What are your suggestions? What
do you think VA could do to encourage more providers into this
program?
Mrs. Benson. Thank you for the question and thank you for
having me here again.
I think one of the first things that we need is provider
education. Providers do not know they have to enroll in the
Electronic Funds Transfer (EFT) system. Providers do not know
that it runs on a Medicare-Medicaid background or backbone
versus a TRICARE backbone. I have had to actually walk urgent
carers through how to file and what system to file it on. That
knowledge is going to be key in getting to providers to come on
board.
What will also be key is providers knowing how much they
are going to get paid. It is fine that there is an acceptable
rate. Most providers I talk to know that it is somewhere within
the Centers for Medicare and Medicaid Services (CMS) rates, but
that it vacillates. For me, and I am a layperson, but looking
back at it going, it is out of IVC, there is a Community Care
Network (CCN), there are already contracts available, it is
mindboggling to me that we cannot use a backbone that is
already there.
Ms. Brownley. Thank you. My time is up. I yield back.
Ms. Miller-Meeks. Thank you, Ranking Member Brownley.
I now recognize Representative King-Hinds for 5 minutes for
any questions she may have.
Ms. King-Hinds. Thank you, Chairwoman and Ranking Member
Brownley. Before I begin, I want to say thank you to Secretary
Collins and the VA team for making good on the promise to cut
down the significant backlog of veteran claims. That progress
matters not just in numbers, but in real lives, in real
families, and in the trust veterans place in in the
organization. It shows what is possible when the VA focuses on
outcomes instead of obstacles.
I am also very encouraged that you are finally moving to
modernize CHAMPVA through the Provider Directory for families,
especially in the territories. I am from the Commonwealth of
the Northern Mariana Islands (CNMI). That is the district that
I represent. Simply knowing which providers are available,
which ones accept CHAMPVA, and where they can turn to for care
is very critical. It is long overdue and it is a positive step
and I want to give a big ups and kudos to all of you.
Even with these improvements, the challenges remains very
serious for my district. The U.S. Government Accountability
Office (GAO) has been very clear. Veterans and their families
in the CNMI and across the territories face some of the highest
barriers to healthcare access anywhere in the United States.
Those same structural gaps, too few providers, limited
specialty care, long distance travel, and virtually no
territory-specific data directly affects the families who rely
on CHAMPVA.
For us, right, on paper CHAMPVA is available everywhere
where the flag flies. In places like the CNMI or Guam, access
can still feel more theoretical than real. I do not think that
we can fix this issue if we cannot--if we do not know what to
measure. Congress cannot hold the VA accountable without the
data.
Today I hope that we can have a conversation about the gaps
in data, right, so that these benefits on statute actually
truly works for everyone, no matter which ZIP Code you live at.
My question then is how can the VA assure Congress that
this program is functioning equitably if it does not track
utilization, access wait times, or outcomes for territories? I
looked, I scoured the Internet, I scoured the GAO reports,
Inspector General (IG) reports, and I do not see any data with
regards to this type of program for the territories.
Dr. Llorente. Yes, thank you very much for that question.
You are right, to the best of my knowledge, we are not tracking
wait times, we are not tracking specific outcomes for the
beneficiaries that are in the program. We are able to look
based on claims, how many claims are coming from what area. We
have, I do not know the specific data, and we are happy to take
it for the record to find out, you know, by territory, the
number of at least claims that have been paid. That gives us a
sense of the services that are being offered in that area.
I think that that is one of the reasons why we have come to
appreciate that a Provider Directory is a very first step, but
is a first step, so that we can begin to even assess the
adequacy of the existing providers that we have. It will also
help us to provide more targeted outreach so that if, for
example, to Mrs. Benson's point, we see that there is an area
that lacks a pediatrician that is a CHAMPVA provider, we will
specifically reach out to all of the pediatricians in that
geographic area and try to work with them, maybe work with a
professional organization, for example, to encourage their
participation in CHAMPVA. It is just an example of what we have
been discussing internally as mechanisms to be able to address
some of these problems.
Ms. King-Hinds. Thank you. I appreciate that. You know, I
do have some data here with regards to Fiscal Year 2023. What
we are seeing in the CNMI is that we have 45 enrollees. We only
have 15 users at a utilization rate of 33.3 percent, which is a
drastic--there is a significant difference with regards to how
the trends are across the United States in comparison to this
utilization number. I just kind of wanted to get a better
understanding of why you think that is and how we can make some
reforms to be able to get more people to be, one, aware of the
program; two, know which care providers that they can go to so
that they can have access to some of this care and, you know,
have the data to be able to justify whatever infrastructure
that need that is needed to be put into place in the
territories.
Dr. Llorente. Yes, ma'am. What I would like to be able to
do is first obtain the more recent data from Fiscal Year 2025.
The data that you cited is in keeping with what we have seen.
That is, overall, we have about 67 percent utilization of
CHAMPVA services within our total group of enrollees. I would
like to see if there has been any difference between the 2023
numbers that you cited and the 2025 currently.
Then, you are right, we need to dig into it and try to have
a better understanding of why there are differences if, in
fact, we find differences.
Ms. King-Hinds. Thank you. I am out of time. Thank you.
Ms. Miller-Meeks. Thank you very much.
The chair now recognizes Representative Cherfilus-McCormick
for 5 minutes for any questions she may have.
Ms. Cherfilus-McCormick. Thank you, Madame Chair, and thank
you, also, Ranking Member, for holding this important hearing.
You know, serving our veterans, and especially their
families, is one of our primary responsibilities and promises.
I am happy that we are looking at CHAMPVA, especially since it
serves over 700,000 people in Florida. We are looking around my
district, 60,000. We have had several questions to the families
who are using CHAMPVA.
While CHAMPVA is not perfect, it provides a lifeline to so
many families, and it must continue to be bolstered and
strengthened to adequately serve those who need it the most.
Over the past few years, I have heard from veterans and their
families about their exposure to environmental toxins while
living near the military installations. Whether it is Red Hill
or Camp Lejeune, we have seen the devastating effects of toxic
exposure on families, like cancer, infertility, and
neurodivergent diseases. This is of concern for military
families, and no military family should be left behind to fend
for themselves.
Dr. Llorente, has your Department looked at expanding the
scope of CHAMPVA to include military families who have been
exposed to toxins?
Dr. Llorente. At this point in time, the eligibility
criteria are in statute and we include or deem that a family
member is eligible based on those existing criteria. Within the
Veterans and Family Member Program, we do have certain
outcomes-related additional programs, such as the Spina Bifida
Program. We have the smaller Vietnam Veteran Women's whose
children have certain disabilities. Then we also have the Camp
Lejeune family Member program. Each of those is designed for
very specific situations, very specific toxic exposures. Those
are the programs that we currently have.
Ms. Cherfilus-McCormick. Do you think there could be other
avenues to provide coverage or do you think that CHAMPVA can
solely handle it?
Dr. Llorente. Well, because I have described some very,
very specific areas, they only cover those areas. We are more
than happy to work with Congress in order to explore any other
areas that, you know, could be assessed and reviewed in the
future.
Ms. Cherfilus-McCormick. I guess my question also is,
because we are thinking about how many people are actually
being exposed, are there other departments or other areas that
we should look into in addition to CHAMPVA? I do not know if
you would know that answer.
Dr. Llorente. I was just about to say I do not think that I
am necessarily prepared to address that question today, but
more than happy to take it for the record and reach out to some
of our other program offices that I think are better suited to
be able to address that question.
Ms. Cherfilus-McCormick. Thank you. While I am optimistic
about the future of CHAMPVA, I understand that the current
program is not without its issues.
Mrs. Benson, I was deeply disturbed to hear that you had to
put over $110,000 promissory note and CHAMPVA refused to cover
a medically necessary hospitalization. This is definitely
unacceptable. No person, especially the spouse of a veteran who
has served our country, should ever have to put a down payment
just to see a doctor.
Dr. Llorente, how typical is this required for people to
put down a down payment?
Dr. Llorente. Congresswoman, I have to be frank with you, I
have not ever encountered this type of a situation before. I
would like to separately reach out to Mrs. Benson to have a
little more detail about the specific circumstances, not only
to be able to address this specific issue, but to have a sense
of, are there gaps that we are not addressing so that we can
figure out what are the steps that need to be taken so it does
not happen to other people.
Ms. Cherfilus-McCormick. Is this the first time you are
hearing of this kind of situation?
Dr. Llorente. It is the first time I am hearing of it, yes,
ma'am.
Ms. Cherfilus-McCormick. Okay. How would you feel if we had
any kind of agreement or arrangement to actually track these
situations and other outliers just so we can make sure that
this is not happening and that there are other obstacles
actually going forward?
Dr. Llorente. I would very much appreciate any similar
types of situations or any other kinds of cases like this,
specifically because it is our duty. As we have discussed, it
is our duty not only to take care of the veterans and their
families and caregivers, but to fix problems that need to be
fixed.
Ms. Cherfilus-McCormick. Thank you so much. I yield back.
Ms. Miller-Meeks. Thank you.
The chair now recognizes Dr. Dexter for 5 minutes for any
questions she may have.
Ms. Dexter. Thank you very much to Chairwoman Miller-Meeks
and to Ranking Member Brownley for again having this very
important hearing. Thank you to our witnesses for coming to
testify today.
According to data from the Veterans Health Administrator's
Office of Integrated Veteran Care, there are over 10,000
Oregonians enrolled in CHAMPVA . To those Oregonians, we have
made a solemn promise, as we have been discussing, that in
return for the immense sacrifices their family members have
made, we will ensure they get access to healthcare services
they need. However, as Mrs. Benson has shared in her testimony,
we continue to fall short on delivering on that promise.
When a family member who is owed a care through the VA is
sick, the last thing in the world that they should be doing is
fighting through red tape to be seen. They most certainly
should not be signing promissory notes, agreeing to pay
hundreds of thousands of dollars for care in case the VA
payment falls through.
As the number of CHAMPVA beneficiaries continue to grow
with the Sergeant First Class Heath Robinson Honoring our
Promise to Address Comprehensive Toxics (PACT) Act
implementation, and if more families are forced to turn to this
coverage because Congress is unable to implement a fix to the
ACA premium tax credit enhancement being taken away, we must be
focused on getting this system to work better for families.
Dr. Llorente, sorry, in your testimony, I was pleased to
see discussion of the need to address the dearth of information
about where CHAMPVA beneficiaries can seek care. As I
understand it, under the current system, beneficiaries have to
individually contact providers, and we have discussed that. It
is obviously frustrating and it needs updating.
It strikes me that one solution to the dearth of option
available to CHAMPVA beneficiaries would be to require
community care network providers to accept CHAMPVA payments.
This would also have the benefit of meaning VA would only have
to maintain a single Provider Directory. Can you comment on any
statutory or regulatory hurdles that would need to be overcome
to consider this as an option?
Dr. Llorente. I appreciate that question. I do not know the
answer to that question. Let me check for a moment with Mr.
Fennell to see if, you know, he has some recognition or
knowledge to be able to address it.
Ms. Dexter. I think it is an unfair thing to ask on the fly
for you to put testimony before a congressional hearing, so I
will just ask that we do--and we ask for many questions to be
responded to, and often we do not get them. If I can just
assure myself that you will get back to me, that is totally
appropriate.
Dr. Llorente. Absolutely.
Ms. Dexter. Thank you.
Dr. Llorente. Yes.
Ms. Dexter. As this committee continues to discuss and
conduct necessary oversight of this program, Dr. Llorente, can
you share the date on which the number of backlogged
applications peaked and the number of pending applications on
that date, like the high point when we had the worst backlog?
Dr. Llorente. Yes, ma'am. It was approximately in May of
this year, 2025.
Ms. Dexter. Okay, thank you. Can you share the percentage
of applications that were approved versus denied in 2025 as
approved compared to the same period in the prior fiscal year?
Dr. Llorente. I do not know the percent approved in Fiscal
Year 2024. I do know that in Fiscal Year 2025, approximately 80
percent of the applications are approved.
Ms. Dexter. Okay, thank you. I have heard that VA, to clear
this backlog, they have set up a separate key for--queue,
sorry, for beneficiaries that have another form of insurance
with an unreported backlog. How many applications are in this
queue awaiting a determination from VA?
Dr. Llorente. I am going to ask Mr. Fennell to address that
question, if you do not mind.
Ms. Dexter. No. Please, Mr. Fennell.
Mr. Fennell. Yes, thank you for the question. Currently, we
are now processing and have the ability to process OHI with the
application. That is a process improvement that we have
included in order to expedite both of the processing of OHI,
other health insurance, and the CHAMPVA application.
Right now we are applying automation to those OHI documents
that are separate and we are able to automate the processing of
a grand majority of those. We had a height of around 300,000
when we initiated the queue that you referenced. I think now we
are in real time, meaning we were processing those as quickly
as we are the applications themselves. I want to say we might
have around 20,000 remaining to process. Again, in applying
this process and automated solutions, that is real time,
meaning over the next week those will be processed.
Ms. Dexter. If I may, to follow up on that, so 300,000
almost immediately. I am assuming these automated tools are
Artificial Intelligence (AI)-generated. Is there a quality
control making sure that the right determinations are happening
for CHAMPVA?
Mr. Fennell. There are. The quality control measures, are
the business rules that are up front that we apply. Some of
that may not necessarily be AI as much as just a business rule
that follows statutory and regulatory guidelines.
Ms. Dexter. Okay, thank you. I am over time. Yield.
Ms. Miller-Meeks. Thank you very much.
The chair now recognizes Dr. Conaway for 5 minutes for any
questions he may have.
Mr. Conaway. Thank you, Chairwoman Miller-Meeks and Ranking
Member Brownley, for putting this hearing together so that we
can conduct a much needed oversight on this very important
program.
As of November 2025, CHAMPVA is providing healthcare
coverage to more than 1 million beneficiaries. At a time when
healthcare prices are increasing and the expiration of the
Affordable Care Act is looming, we must strengthen this
healthcare program for independents and survivors of veterans.
In my State of New Jersey, premiums are projected to
increase by 174 percent. The average annual premium cost could
jump almost $2,800 on average. For some, it could mean that
costs will go up by tens of thousands. This is unacceptable. I
encourage my colleagues to find a solution to this looming
cliff that so many Americans are facing, will face with respect
to their healthcare if a solution is not found to the problem
of the expiration of the premium tax credits.
I am curious to know, Ms. Llorente, do you anticipate that
the expiration of the ACA tax credits will impact enrollment
for CHAMPVA?
Dr. Llorente. Thank you very much. I appreciate that
question, and I truly do not know the answer. We still would
need the veteran sponsor to meet the eligibility criteria. That
becomes, you know, sort of the first thing that has to occur. I
simply do not know how many spouses or dependents of veterans
that are 100 percent service-connected, permanent, and total,
are currently receiving ACA benefits.
Mr. Conaway. Are you conducting any planning in
anticipation of the some 20 million people who are going to
lose these tax credits? Are you doing any anticipatory planning
to prepare for a potential influx of new applications as the
people can no longer afford their health insurance benefit or
health insurance under the ACA?
Dr. Llorente. Our primary planning, and we do work very
closely with projections and enrollment and as well as with VHA
Fiscal, has been looking at the increasing numbers year over
year of beneficiaries who have been enrolling in CHAMPVA. For
many years that figure was pretty steady, about 5 to 8 percent
year-over-year growth. Then PACT Act was enacted. That growth
went to about 13 to 14 percent. During the past year, we have
seen almost a 22 to 23 percent increase. That in and of itself
we are and have been tracking very, very closely.
We are engaging in projections so that we assure that we
have sufficient budget currently and in future years to address
the healthcare needs based on past expenditures with
adjustments for those increases. Have we factored in impact
from ACA specifically? No, sir, at this point we have not.
Mr. Conaway. Do you know then how many of your enrollees
also have insurance under the ACA? Do you have that number?
Dr. Llorente. I do not. Let me check with Mr. Fennell. Do
you know?
Mr. Fennell. Thank you, sir, for the question. I do not
know the answer to that question, but I am apprised of the
eligibility criteria and I do not see a situation where that
changes with the ACA tax credit, which is permanently and
totally disabled.
Mr. Conaway. Just reclaim my time because I am running out
of time.
Mr. Fennell. Oh, sorry, sir.
Mr. Conaway. I just want to get to this question of the
lack of providers in particular markets and what is being done
about that. Now, typically, I mean, as one who ran a practice
years ago, you know, you sort of have to determine--when you
determine to bring on an insurance policy, how much does it
pay? Is it worth my time compared to the other insurances that
I accept covering, you know, people who can come to the office?
Is one problem that the CHAMPVA is not paying enough? Two,
that it is perhaps too difficult for people to enroll in
CHAMPVA? Have you looked into that and how are you addressing
those factors which I am sure are impacting the number of
physicians who are accepting CHAMPVA patients?
Mr. Fennell. Yes sir, thank you, and happy to answer that
question. We are required by law to pay like or similar to
TRICARE. That is actually those are the payment methodologies
that are loaded into our system, our TRICARE methodologies. The
other aspect to this is we are normally a secondary payer
benefit. If they have Medicare or they have other health
insurance, that is going to be billed first and I would imagine
that would be a primary concern to the treating physician. If
it does get to a secondary payment, we would pay like or
similar to TRICARE.
Ms. Miller-Meeks. Thank you very much, Dr. Conaway.
I now recognize myself for 5 minutes.
If I can, I am just going to have a point of clarification.
Certainly myself and members of my party and members of this
committee want to make sure that healthcare costs are brought
down for everyone, not just a select few that may be on
enhanced premium tax credits. The premium tax credits under the
ACA are not expiring, only the enhanced premium tax credits are
expiring. I thought I would put forth that clarification since
this is entered into the record.
Additionally, we do not force providers to accept Medicaid.
We do not force providers to accept TRICARE. Being a provider
and a veteran, it seems to me that forcing providers to accept
CHAMPVA who are in the community, would that be considered
indentured servitude? I will pose that question to Dr. Llorente
and you can submit an answer in writing.
Thank you for that. Just making those points valid that we
look at the constitutional nature of what it is that we may
require of someone to do.
Dr. Llorente, what is the industry standard for the amount
of time to process claims, both paper and electronic? Then how
does the VA compare, if you have that information?
Dr. Llorente. Thank you, Chairwoman. I do not know the
answer to that question, but happy to take it for the record
and then provide the comparative numbers.
Ms. Miller-Meeks. Then I applaud the efforts at getting
through the backlog and applying more technology to improving
backlog and also your efforts in trying to keep family members
and providers up to date on the status of their claims. To that
end, is the VA using artificial intelligence or augmented
intelligence to improve both applications, the claims process
or status, and updates for that? If so, how and, if not, why?
Dr. Llorente. Thank you very much for that question. I am
going to ask Mr. Fennell to address that because he has way
more technical savvy than I do.
Mr. Fennell. Thank you for the opportunity to answer that
question. It began, as I answered before, with just with
business rules and loading those into the system to make
automated decisions. When it comes to artificial intelligence,
which brings in an additional capability, we are starting to
apply some of the those capabilities when it comes to these
newer modernized platforms that we are moving into for
processing both claims and eligibility applications.
Ms. Miller-Meeks. Mrs. Benson, I think that you have
answered this question in your testimony, but I just want to
reiterate it. Would it help to have a Provider Directory for
families and caregivers? If so, are you supportive of
Representative Kiggans' legislation?
Ms. Benson. Thank you for the question. I am not familiar
with the legislation, but I can say it would be helpful to have
both a contracted network and a Provider Directory. Yes. Thank
you.
Ms. Miller-Meeks. Great. Thank you. I yield back.
I want to thank all our witnesses for being here. I am
going to recognize Ms. Brownley for any closing remarks you may
have. Oh, oh, my apologies. We have another member snuck in.
The chair now recognizes Representative Kiggans for 5
minutes for any testimony she may have.
Ms. Kiggans. Thank you, Madame Chair, for having me here
today to discuss the Civilian Health and Medical Program of the
Department of Veteran Affairs, or CHAMPVA, and to highlight how
Congress can improve this program for our veteran caregivers
and dependents.
I represent Hampton Roads, Virginia, which is home to
thousands of veteran families who use the CHAMPVA system to
support our Nation's veterans and to access their veteran
healthcare. Caregiving requires tremendous sacrifice, but
access to quality healthcare should not be one of them.
CHAMPVA is a vital program for the caregivers and
dependents of permanently disabled veterans. It ensures they
can continue to support the veteran in their lives and still
receive the healthcare services they require. However, it can
be difficult for caregivers and dependents to find providers in
their community that accept CHAMPVA. On most occasions,
caregivers have to do their own research and find specific
providers that will take their coverage.
To rectify this situation, I introduced the Clarity on Care
Options Act, which directs the VA's Community Care Network to
create a public-facing list of all providers who are in network
for CHAMPVA enrollees. We must make this provider information
accessible to caregivers and dependents of disabled veterans.
The easier we make finding healthcare for our caregivers, the
more time they can spend with their loved ones.
I want to thank our witnesses for taking the time to
educate us about the gaps we see in this program and what we
can do to help increase support to those who support our men
and women who served our country. With that, I have another few
questions for our witnesses if there is time.
When it comes to finding providers that accept CHAMPVA, how
has your experience, and this is for Mrs. Benson, how has your
experience been? Is there any difficulty locating specialty
healthcare providers who accept CHAMPVA?
Mrs. Benson. Thank you for the question. Yes, there is a
terrible issue. Back to the hospitalization I mentioned, I had
a daughter who needed specialty care. I called 26 hospitals
across the Nation, only 1 would take her. Even today I pay out
of pocket. No mental healthcare provider, and I am in Florida
between very two large metropolises, accepts CHAMPVA for teens.
Even for myself, if it is not hospitalization, which is
mandated to file, only one major network takes it. We end up
paying most of our care out of pocket, above and beyond CHAMPVA
and cash.
Ms. Kiggans. Thank you. Mr. Zenner, from your perspective,
what barriers do you often see beneficiaries of CHAMPVA face
when it comes to accessing their benefits?
Mr. Zenner. Yes, thank you for the question. Very similar:
lack of education of providers, confusion with the CHAMPVA card
itself are two of the biggest barriers that we currently see as
County Veteran Service Officers.
Ms. Kiggans. Would a directory or a list of providers of
sorts be beneficial then?
Mr. Zenner. Yes, ma'am.
Ms. Kiggans. In these cases for sure.
Mr. Zenner. Yes, ma'am.
Ms. Kiggans. Then for Dr. Llorente, many caregivers report
learning about CHAMPVA only years after becoming eligible, in
most cases, as the program is currently. How do veteran
dependents find out about CHAMPVA?
Dr. Llorente. Yes, thank you very much for that question.
There are a couple of different ways. One is that part of the
changes that have occurred in VBA when the veteran becomes
permanent and total 100 percent, part of the packet that they
receive describing the rating includes information about
CHAMPVA for their dependents and how to enroll in the program.
A second way is the CHAMPVA program itself does do direct
outreach to potentially eligible beneficiaries, advising them
of the program and how to apply for it. We are continuing to
also engage in additional outreach efforts because one of the
things that we have discussed internally is that we could
certainly be doing a better job of putting promoting this
benefit.
Ms. Kiggans. Specifically, how is the VA improving the
CHAMPVA's phone and customer service operations given reports
of long wait times and inconsistent information.
Dr. Llorente. We have engaged in a series of steps toward
that. One is we have increased contractor support that can be
specifically surged during peak times.
In addition to that, we are working on implementing some
new telephony systems so that it will begin to offer more in
the way of self-service, so that those issues that can be
addressed via self-service are addressed. Then it moves those
clients, those persons that need agent-assisted calls, it sort
of, you know, separates out the ones that can be handled via
self-service.
In addition to that, we are looking at our workflows,
streamlining some of those, being able to standardize some of
the workflows as well, because there are things that we have
identified that are being done, you know, with too much
variance, and that is also then leading to some of the delays.
Just a few examples.
Ms. Kiggans. Yes. Great. Thank you for working on that.
Last question, as the VA can--no, I am sorry. Maybe I will save
it for later.
Thank you. I yield back.
Ms. Miller-Meeks. Just to know that I am fair to everyone
in the hearing room. Thank you. Your time has expired. The
gentlewoman yields back.
I now recognize Ranking Member Brownley for any closing
statements you may have.
Ms. Brownley. Well, I would just say, Madame Chair, I thank
you for having this hearing. I think it is--we need to get the
VA back to briefing staff so we can keep updating on, you know,
what progress is being made. That is the frustration. We do not
have a plan in front of us. We do not have a timeline in front
of us. There is no way for us to do the oversight that we
really need to do.
This is an important program that we need to get right. I
think we are all clear on where the problems lie and what needs
to be done. It is just--it is a matter of doing it. If the
Secretary was willing to hire more people or give people more
overtime to deal with the backlog, we need to do the same to
all these other problematic areas to get them, you know, up to
speed and running.
I honestly believe that if we accept the fact that CHAMPVA
is more like an insurance plan than a medical care benefit, you
will see directly what needs to be done and how to do it if you
just follow the model of what insurance plans do, including a
directory of providers, whatever. You know, we need to have the
oversight. I hope we can have another hearing to do our due
diligence as we move forward.
I thank you all for being here. Mrs. Benson, thank you for
being here. Thank you for all the help that you do for so many
other veterans who need your help, veterans, their families,
and caregivers who need your help and support.
I yield.
Ms. Miller-Meeks. Well, certainly it is an important
hearing. I appreciate, Dr. Llorente, what you and the office
has done to improve the backlog. Then your continued work on
keeping family members and caregivers, trying to improve the
knowledge of where their claims are. Then the other efforts
that we need to take on provider education, as Mrs. Benson and
Mr. Zenner had said, how to file claims and how much they are
paid so that we can get providers into this very important
program to make sure that both family members, spouses, and
caregivers are aware and have access to the benefits that those
veterans have earned for them.
I would like to take this time to thank everyone for their
participation. Thank you so much for your patience and I do
apologize. Although it was out of my hands, I still feel it is
necessary to apologize for the inconvenience to you all and to
those who wanted to participate in today's hearing. I
appreciate the discussions we have had on this important topic
and we will continue to have oversight.
The complete written statement of today's witnesses will be
entered into the hearing record.
I ask unanimous consent that all members have 5 legislative
days to revise and extend their remarks and include extraneous
material. Hearing no objections, so ordered.
I thank the members and the witnesses for their attendance
and participation today. This hearing is now adjourned.
[Whereupon, at 4:44 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 Maria Llorente
Chairwoman Miller-Meeks, Ranking Member Brownley, and distinguished
Members of the Subcommittee. Thank you for the opportunity to testify
today about the Civilian Health and Medical Program of the Department
of Veterans Affairs (CHAMPVA), a vital program that provides health
care coverage to eligible spouses, children, survivors, and caregivers
of qualifying Veterans.
Joining me today is Mr. David Fennell. He is the Director of
Veteran and Family Member Programs in the Office of Integrated Veteran
Care.
CHAMPVA plays a critical role in supporting the families of
Veterans who have made profound sacrifices in service to our Nation. My
testimony today will provide an overview of the program's eligibility
criteria, current operations, recent improvements, and opportunities
for continued collaboration with Congress to ensure timely, efficient,
equitable access to care.
Authorized under the United States Code, Title 38 Section 1781,
CHAMPVA provides health care coverage to eligible spouses, surviving
spouses, and children of Veterans who are permanently and totally
disabled due to a service-connected disability, who died as a result of
a service-connected condition(s), or who died while rated permanently
and totally disabled from a service-connected condition(s). It also
covers certain survivors of persons who died in the line of duty and
certain Primary Family Caregivers under the Program of Comprehensive
Assistance for Family Caregivers. To be eligible for CHAMPVA, the
individual cannot be eligible for TRICARE.
As of November 2025, CHAMPVA provides health care coverage to more
than one million beneficiaries. The program receives approximately
4,000 new applications per week. More than 90 percent of medical and
pharmacy claims are processed electronically within days of receipt,
ensuring timely reimbursement and continuity of care.
Under the leadership of Secretary Douglas A. Collins and thanks to
recent reforms, the application backlog--previously exceeding 70,000
cases--has been eliminated. New applications are now processed in a
matter of days. The appeals backlog has also been reduced from over
20,000 to approximately 1,000, with continued progress underway. These
improvements reflect the Department of Veterans Affairs' (VA)
commitment to Veteran-first service delivery, accountability, and
efficiency.
Under the last Administration, CHAMPVA faced significant delays in
application and appeals processing due to increased demand, staffing
constraints, and reliance on legacy manual systems. Some applicants
waited over 150 days for determinations. Under Secretary Collins'
leadership, VA implemented a two-pronged strategy: authorizing overtime
for application processors and introducing enhanced process engineering
and new automation to streamline workflows. These actions have assured
timely access to benefits for eligible CHAMPVA beneficiaries.
VA is modernizing CHAMPVA operations to reduce bureaucracy and
improve the user experience. In December 2025, we will complete the
transition to a more automated application processing system,
increasing efficiency and reducing manual workload. These efforts align
with VA's broader digital transformation strategy and support the
Department's goals of transparency, reduced administrative burden, and
improved outcomes for Veterans' and VA beneficiaries.
Access to accurate provider information is another area of focus.
Although CHAMPVA beneficiaries may see any provider who accepts
CHAMPVA's allowable rates, VA acknowledges that beneficiaries may
experience difficulty identifying participating providers or confirming
whether a provider is accepting new patients. We are working to improve
how provider information is presented and maintained, including
updating publicly available guidance and strengthening communication
with providers who bill CHAMPVA.
We appreciate the continued interest in strengthening CHAMPVA. Over
the last few months, VA has made significant strides in eliminating
backlogs, modernizing systems, and improving access. We remain focused
on delivering timely, high-quality service to those who have sacrificed
so much.
Conclusion
This concludes my statement. We look forward to responding to any
questions that you may have.
Prepared Statement of Caira Benson
Chairman Miller-Meeks, Ranking Member Brownley, and Members of the
House Veterans' Affairs Subcommittee on Health, thank you for inviting
me to testify today. It is my honor to return to further the discussion
on the inefficiencies and inequalities within the Department of
Veterans Affairs' (VA) Civilian Health and Medical Program of the
Department of Veterans Affairs (CHAMPVA).
At the Code of Support Foundation (COSF), we work with veterans and
their families every day. Our digital resource hub, PATRIOTlink, has
served over 67,000 military community members to find needed supports
for active duty servicemembers, veterans, caregivers, family members,
and survivors. Every day our case management team works to connect
active duty servicemembers, veterans, caregivers, family members, and
survivors to local, regional, national, and government partners to
achieve needed financial, social, physical health, and mental health
supports to achieve stability. At COSF, we are in the records daily and
in-tune with the needs of the military community.
But I am not just here as an employee of a veterans' non-profit. I
am here as a caregiver, advocate, and a CHAMPVA user. I care for my
husband who deployed twice to Iraq as a combat engineer between 2003-
2006. My husband suffered multiple Traumatic Brain Injuries (TBIs)
during his years in service; however, it would take until 2018 to
formally diagnose those TBIs, despite a clear record of evidence. It
would take another year to figure out his case was complicated by toxic
encephalopathic process, most likely due to chemical exposures. Today,
Eric is unable to work, needs full-time care, and is seen by a
university neurological team due to the complexity of his case.
My five children and I enrolled in CHAMPVA in 2017 when my husband
was awarded Permanent and Total status for his service-connected
injuries. We breathed a sigh of relief knowing that we would have the
safety net of health insurance for myself and our children, three of
whom have needed specialty medical care through the years.
I testified in June of this year to this subcommittee about the
nightmare navigating CHAMPVA has been for our family. Highlights of
that nightmare include having to sign a $110,000 promissory note to
ensure a needed hospitalization occurred in the chance that CHAMPVA
refused payment, putting needed medical care on hold while waiting 6
months for preauthorization, being sent to collections when CHAMPVA
claim payments didn't occur in a timely manner with one provider
waiting over 27 months to receive payment for services. CHAMPVA's
``appropriate care'' has felt anything but appropriate. Indeed, I still
find our family's health needs are in arrears because we hesitate to
use the complicated system which many in my area will not file.
I will not rehash my testimony given in June of this year - I know
the committee is interested in how the situation looks for CHAMPVA
users today, if the changes have been made, and how those changes have
been received since my last testimony.
I commend VA for finally clearing the CHAMPVA application backlog.
It is beyond time to process applications in real time. I also was
overjoyed to hear that claims being submitted electronically are being
paid quicker than previously.
Yet, even with that good news, the situation on the ground for
CHAMPVA users remains murky. While the application backlog is cleared,
only two families I knew waiting on their decisions have received
notifications of such to date.
Provider acceptance of CHAMPVA still remains a challenge. As a user
myself, I had a medical complication this year which required me to
travel over an hour for out-patient procedures as they were the nearest
provider willing to file.
Even living in last year's fastest-growing county in the Nation, I
still cannot find a pediatrician who will file CHAMPVA for primary
pediatric care for my children. I still pay out-of-pocket for my
children's mental health providers as we have yet to find a provider
who accepts CHAMPVA.
I know I am not alone. At COSF, one of our most frequent requests
is mental health supports for dependents. We have multiple national and
regional providers we work with to provide such supports for our
clients. Five of these take TRICARE and refuse to take CHAMPVA. To
quote one, ``VA is too difficult to work with.''
I feel those words deeply. Indeed, the difficulty of the process
has made me personally stop filing for reimbursement. It is one more
bureaucratic fight that caregivers like me do not need.
It is hard to place blame on providers for declining to accept and
file CHAMPVA. Indeed, VA has made it difficult on providers filing
claims and on users looking for providers. There is no known provider
network or contracts outside of CHAMPVA's pharmacy component run by
OptumRX.
I have talked to multiple providers who tell me there is no
published fee schedule. While there is a ``CHAMPVA acceptable pay
rate,'' most providers do not know what that is until they are paid or
until the patient receives their Explanation of Benefits (EOB). Most
providers tell me they understand the acceptable rate is based on
Centers for Medicaid & Medicare Services (CMS) rates, however pay can
vacillate lower than the Medicare rate. By agreeing to file the claim,
providers are barred from recouping any difference between the expected
and paid rates.
Claims filing is messy, at best, with many providers still filing
via paper claims through either the local VA Medical Center (VAMC) or
CHAMPVA mail-in centers, depending on what current local advice is.
Several providers I spoke to were unaware of the ability to file claims
electronically.
Claim payment times are not guaranteed. Some claims are paid in
weeks; some claims are paid in years. Payments for claims are delayed
by filing codes that are, unbeknownst to the filer, not accepted by
CHAMPVA causing denials, and requiring refiling. Delayed payment means
that I routinely talk to CHAMPVA users who have their accounts sent to
collections by providers due to the length of time between claim filing
and claim payment. Indeed, I had two such discussions just last week.
I recently learned that VA now offers an app where family members
can look up CPT codes to ensure services are covered. And I ask this -
why am I, as a caregiver and dependent, required to do what every other
insurance agency does through yearly contract updates to their provider
network?
As they did in the Senate Veterans' Affairs Committee on May 21,
2025, VA has argued in the past that CHAMPVA is not an insurance
product, it is a medical service. I remain steadfast--the industry, the
Federal Government, and, more often than not, the VA treats CHAMPVA as
an insurance product. For instance, like those covered by Medicaid,
Medicare, or TRICARE, CHAMPVA enrollees may not take part in the drug
cost reduction programs offered to patients on fixed or low incomes. If
we choose to shop for insurance through the Health Care Marketplace,
CHAMPVA enrollees are not eligible for either financial assistance nor
advance premium tax credits. Every year, CHAMPVA enrollees receive a
1095-B attesting to the fact that CHAMPVA counts as minimum essential
coverage under the Affordable Care Act. Finally, even VA states that
CHAMPVA is only available to caregivers enrolled in VA's Program for
Comprehensive Assistance for Family Caregivers (PCAFC) when they have
no other health insurance. Thus, CHAMPVA identifies itself as an
insurance plan when it offers proof of coverage and bars use of its
plans in the face of other coverage.
CHAMPVA provides EOBs, approves and denies diagnostic codes,
approves and denies medical treatment codes, and remits payment for
enrollees to providers for approved services rendered by the medical
community. CHAMPVA even has out-of-pocket maximums, deductibles,
copays, and a medication formulary with tiered pricing. With the
exception of the difficulty of use, CHAMPVA feels like every other
insurance product I have ever received through an employer.
Indeed, the stance that CHAMPVA is not an insurance product is
detrimental to veterans' families. At COSF, I recently walked a
Permanent and Totally disabled veteran through enrollment for his wife
into CHAMPVA. Prior to reaching out to us, this veteran had purchased
insurance for his dependent through the Healthcare Marketplace, not
understanding that CHAMPVA provided Patient Protection and Affordable
Care Act, or ACA, complaint coverage.
I am positive we will hear today from VA that CHAMPVA is equivalent
to TRICARE. Except, we users know it is not. TRICARE has contracted
rates and a published fee schedule. TRICARE has mandated electronic
filing and a clear appeals system. Treatments we know are covered under
TRICARE are not always covered under CHAMPVA. Some other major
differences:
TRICARE offers TRICARE Young Adult allowing for coverage
for dependents 18-21 (23 if in college). CHAMPVA coverage ends on the
dependents 18th birthday unless enrolled in school.
TRICARE offers coverage for stepchildren until the
marriage ends in divorce. CHAMPVA's stepchild coverage ends at 18 or
when the child leaves the domicile, meaning a stepchild who changes
their address to go to college could be dropped.
TRICARE retirees may choose Federal Employees Dental and
Vision Insurance Program (FEDVIP) which provides orthodontia coverage
for dependents. CHAMPVA enrollees may only choose VA Dental Insurance
Program (VADIP), where orthodontia was cut from the leading plan this
year (DeltaDental).
Appeals for denied coverage under CHAMPVA are difficult to navigate
as well. I recently had a caregiver call me because her child's recent
claim for an ambulance ride during an anaphylaxis event was denied by
CHAMPVA. It took over an hour of digging claims denial letters, EOBs,
and CPT codes to understand what had happened - the denial was due to
an inaccurate billing code which was billed under both an individual
code and a packaged CMS code. CHAMPVA had paid the packaged code but
denied the individual code, and we do not believe the CHAMPVA enrollee
will be charged for the ambulance ride.
The denial letters listed three appellate structures: a
supplemental claim or higher-level review through the Veteran Family
Member Program (VFMP) appeals office or an appeal to the Board of
Veterans' Appeals. Yet, the CHAMPVA website states there is a clinical
appeal option that was not mentioned in the denial letter. How does a
CHAMPVA user without extensive knowledge understand the next steps to
appeal a denied claim? What was also glaringly missing? Something
considered routine in today's world of denied insurance claims - an
option for a third-party review for denied services.
In short, CHAMPVA remains a complicated mess for users. The
historically large gap between enrollees and users validates this
difficulty. In the 2024 congressional report, Health Care for
Dependents and Survivors of Veterans (RS22483), the gap is evidenced
across the decades with 2024 having over 700,000 enrollees but only
488,000 users.
While VA has announced positive steps to easing some of the known
CHAMPVA problems, CHAMPVA fixes are far from complete.
CHAMPVA users need:
Statutory change to bring parity to stepchildren;
Statutory clarity to allow for a contracted provider
network with clear, contracted CPT codes and published fees, similar to
the modernization of CHAMPUS to TRICARE;
Regulatory updates establishing a provider network with
clear, contracted CPT codes and published fees;
Mandated electronic claims filing; and
Clarity in claims appeals processes, including a third-
party review.
We also need you as a subcommittee to remember who receives CHAMPVA
eligibility - TRICARE ineligible dependents of permanently and totally
disabled veterans, survivors of those same veterans, and those enrolled
in PCAFC with no other health insurance. In other words, our most
vulnerable community members.
In VA's mission, ``To fulfill President Lincoln's promise to care
for those who have served in our Nation's military and for their
families, caregivers, and survivors,'' CHAMPVA is failing. As a
community, we cannot continue to allow this egregious lapse of coverage
for those who need it most.
We at COSF stand ready to work alongside VA and this Committee to
help modernize CHAMPVA. I thank you for your time and attention, and I
look forward to your questions.
Prepared Statement of James Zenner
Chairman Bost, Ranking Member Takano, and distinguished members of
the Committee, on behalf of the National Association of County Veteran
Service Officers (NACVSO), we thank you for the opportunity to provide
written testimony for the record. We value this Committee's steadfast
commitment to improving the benefits, services, and systems that
directly impact veterans and their families across the Nation.
To begin, NACVSO would like to extend sincere appreciation to the
staff at the CHAMPVA offices for their extraordinary work in reducing
the application backlog. We are hearing consistent reports from our
members that CHAMPVA applications are now averaging close to 10 days
for initial processing, with some cases moving in as few as four. This
progress is not merely administrative--it is lifesaving. It means
eligible dependents gain timely access to health care coverage without
enduring prolonged periods of uncertainty. These teams deserve real
credit for this achievement.
Our testimony today is offered with respect for our partners at
CHAMPVA and with a shared goal: to identify practical refinements that
would increase accessibility, transparency, and efficiency for eligible
family members and for the Government Veteran Service Officers (GVSOs)
who serve them.
1. Modernizing CHAMPVA Applications by Enabling Digital
Submission
As previously mentioned, NACVSO represents government-employed
veteran service officers across the country. As accredited
representatives, these officers act as the primary navigators for
veterans and their families who rely on them to access the benefits
they have earned. Yet, when assisting dependents with CHAMPVA
applications, these advocates face a significant barrier: there is
currently no mechanism for GVSOs to submit CHAMPVA applications
electronically.
To help a dependent apply, a GVSO must print out the application,
complete it by hand with the applicant, and then fax or mail it to the
CHAMPVA office. This process prevents accredited representatives from:
receiving a digital confirmation of submission,
tracking the application's progress, and
providing timely updates when a dependent calls for
assistance.
Meanwhile, veterans eligible for VA.gov have access to online
submission portals--but many dependents do not, as they lack a VA.gov
profile and therefore cannot fully engage in self-service options.
CHAMPVA applications are ready for modernization. NACVSO recommends
the development of a digital submission workflow, modeled after the
Veterans Benefits Administration's successful National Work Queue
rollout. A similar system for CHAMPVA would:
generate submission confirmations for applicants and
accredited reps,
show real-time status updates (e.g., ``received,'' ``in
review,'' ``decision made''),
reduce administrative burden on CHAMPVA staff, and
increase trust and transparency for families.
A viable path forward may include enabling eligible survivors and
dependents to obtain VA.gov access specifically for benefits and
CHAMPVA-related documentation.
In parallel, expanding VA Form 21-22 authority--which formalizes
representation between claimants and accredited organizations--to
include the Veterans Health Administration and its subordinate entities
(including CHAMPVA offices) would allow NACVSO's accredited officers to
communicate directly with CHAMPVA staff. This would reduce delays,
minimize errors, and empower GVSOs to resolve issues on behalf of
families more efficiently.
2. Increasing Provider Awareness and Participation
A persistent challenge reported nationwide is the lack of
understanding among community healthcare providers about what CHAMPVA
is, who it covers, and how reimbursement works. Many providers have
never encountered CHAMPVA before; some conflate it with TRICARE or with
VA Community Care. This lack of knowledge discourages provider
participation and creates avoidable access-to-care barriers for spouses
and dependents.
NACVSO recommendations to expand provider awareness include:
Targeted campaigns to large provider networks, hospital
systems, and independent practices explaining CHAMPVA coverage and
billing processes.
Provider-focused training materials, such as webinars or
downloadable toolkits, distributed through VA's Office of Community
Care and regional CHAMPVA liaisons.
Inclusion in electronic health record (EHR) billing
libraries, ensuring CHAMPVA appears as an easily selectable insurer.
Partnerships with professional associations to
disseminate CHAMPVA guidance, if not already active.
These efforts would immediately expand access for eligible
dependents by reducing confusion at the point of service.
3. Redesigning CHAMPVA Identification Cards
Community providers frequently confuse the CHAMPVA identification
card with the VA Community Care card, resulting in some instances where
a dependent is turned away for care. This confusion burdens families
and forces repeated follow-up with CHAMPVA and GVSOs.
NACVSO recommends that VA explore restyling CHAMPVA eligibility
cards to create a distinct, easily recognizable format. Clear
differentiation--both visually and textually--would minimize confusion
and support smoother interactions with community providers nationwide.
4. Addressing the CHAMPVA Coverage Gap for Dependent Students
A particular issue arises during the transition period when a
dependent turns 18. Under current policy, CHAMPVA eligibility lapses
unless the dependent is enrolled full-time in school and provides
verification to CHAMPVA. Unfortunately, the processing time for this
school enrollment certification often stretches eight to 9 months,
creating a substantial coverage gap.
During this period:
dependents incur medical expenses out of pocket,
families must attempt reimbursement long after the care
has occurred,
claims may be forgotten or lost, and
dependents undergo administrative burdens during what
ought be a routine eligibility continuation.
This gap is perplexing given that VBA has already determined
eligibility for the underlying veteran benefit that establishes
Dependent's Education Assistance and CHAMPVA access. NACVSO recommends
a few potential mitigation strategies such as:
Provisional Continuation of Coverage:
Allow dependents to maintain uninterrupted CHAMPVA
coverage for a defined period (e.g., 6 months).
Direct Data Exchange with Educational Institutions:
Establish an automated system where schools can
provide enrollment verification directly to CHAMPVA, similar
existing VA education certification offices.
Online Certification at VA.gov for Dependent Students:
Similar to existing VA.gov profiles, access would
allow dependents to upload proof of enrollment through an
online portal that generates a timestamp and receipt.
Pre-verification reminders:
Create automated notices 6 months before the
dependent's 18th birthday.
Addressing this single chokepoint would eliminate a
disproportionate amount of confusion and financial strain for thousands
of families each year.
Overall CHAMPVA is performing well, and the reduction in
application backlog stands as clear evidence of the dedication of VA's
workforce. But as with any successful program, continued refinement is
both necessary and possible.
Government Veteran Service Officers are uniquely positioned to
assist VA in improving the CHAMPVA experience for eligible family
members. As the front-line, accredited advocates charged with helping
veterans and their dependents navigate Federal benefits, GVSOs see
these challenges--and potential solutions--every day. NACVSO stands
ready to support VA and this Committee in modernizing processes,
expanding access, and ensuring that the families of our veterans
receive the timely, reliable health coverage.
Thank you for your continued leadership and for the opportunity to
provide testimony. NACVSO remains committed to working with the
Department of Veterans Affairs, CHAMPVA leadership, and Congress to
strengthen all programs for those who served and those who stand
alongside them.
Jim Zenner,
Policy Director, NACVSO
Director of Military and Veteran Affairs of Los Angeles County
Statements for the Record
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Questions for the Record Submitted by Marianette Miller-Meeks
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Response to Questions for the Record Submitted by Caira Benson
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Response to Questions for the Record Submitted by U.S. Department of
Veterans Affairs
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Response to Questions for the Record Submitted by National Association
of County Veterans Service Officers
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Prepared Statement of Paralyzed Veterans of America
Chairwoman Miller-Meeks, Ranking Member Brownley, and members of
the subcommittee, Paralyzed Veterans of America (PVA) appreciates this
opportunity to share our views on how to strengthen the Civilian Health
and Medical Program of the Department of Veterans Affairs (CHAMPVA) for
survivors and dependents.
CHAMPVA is a comprehensive healthcare program for the spouse or
widow(er) and children of an eligible veteran. The Department of
Veterans Affairs (VA) shares the cost of certain healthcare services
and supplies provided through this program with eligible beneficiaries.
It may also provide benefits to the Primary Family Caregiver through
the Program of Comprehensive Assistance for Family Caregivers.
Accessing healthcare through CHAMPVA can be challenging for several
reasons. Until recently, just getting an initial application for
CHAMPVA health coverage approved took months. In late November, VA
announced it eliminated a backlog of more than 70,000 CHAMPVA
applications. They are processing new applications in a handful of
days, and the department says they can process more than the 4,000 new
applications per week that it currently receives.
They substantially reduced the number of pending appeals as well,
from roughly 20,000 earlier this year to about 1,000 today. Their
success in reducing the backlog for both claims and appeals is properly
attributed to Secretary Collins' decision to use overtime pay for VA
staff to get the job done, while streamlining the process and
leveraging automation to speed it up. VA expects to move to a more
automated application processing system this month, which will increase
the efficiency of processing CHAMPVA applications. It will also ensure
that most medical services and pharmacy claims are electronically
processed within days of receipt for more timely payment.
There may be some lingering concerns regarding payment holds for
CHAMPVA providers. These holds are placed on providers who have not
enrolled in electronic funds transfer, and we understand there are
thousands of them in this position. The lack of timely reimbursements
has plagued the program, and we urge the department to work with these
providers to resolve the problem as quickly as possible.
Finding providers that accept CHAMPVA has always been a vexing
issue for several reasons. The paperwork burden for the program is
high, insurance denials can be troublesome, there is no network to
manage rates or fee schedules, and reimbursement rates are extremely
low, making those provided by other Federal and private plans far more
attractive. We encourage Congress to work with VA to address each of
these problem areas.
Coverage for a veteran's children under CHAMPVA currently expires
when they turn 18, unless they are full-time students. In this case,
they continue to receive coverage until they turn 23, stop attending
school full-time, or get married. However, for most Americans with
health insurance, their adult children can remain on their plan until
age 26 with no separate premium, as mandated in the Patient Protection
and Affordable Care Act (ACA) (P.L. 111-148). CHAMPVA and the
military's TRICARE programs were not affected by the ACA, so they
required separate congressional action to extend these benefits to
children up to age 26. This discrepancy was addressed for TRICARE in
2011 and H.R. 1404, the CHAMPVA Children's Care Protection Act would
fix this for VA's CHAMPVA program.
The delay in making this change to CHAMPVA has adversely impacted
several of our members, including PVA member Amy and her husband. She
served honorably in the U.S. Marine Corps before an SCI/D cut her
military service short. Her husband served in the Marine Corps as well,
but injuries he sustained in Operation Desert Storm curtailed his
military career, too. Both have 100 percent disability ratings from the
VA. Their two boys have severe immune deficiencies that were caused by
their parents' exposure to hazards during their military service. As a
result, the boys require weekly plasma infusions to keep them alive.
These infusions cost thousands per month, and they cannot afford to pay
for them out of pocket. They rely on CHAMPVA to provide this life-
saving care and suffered tremendous angst when their oldest child
turned 18. Fortunately, he became well enough with the infusions that
they were able to keep him in school and CHAMPVA until he turns 23 in
March 2026. The younger child is currently 17 but he has additional
comorbidities that may not allow him to do the same. The family is
straining under the pressure that the lack of action from Congress has
put on them, and unless legislation like this is passed, there is a
very real possibility that both children will age out of the program
next year.
The VA testified in opposition to the companion measure to this
bill during a May 1, 2025, Senate Veterans' Affairs Committee hearing.
The witness correctly stated that CHAMPVA was not affected by the ACA,
but we disagree with VA's assertion that it is not health insurance
because it clearly functions like it. For example, certain types of
care and services require preauthorization. This approval is extremely
important, and the failure to obtain it may result in denial of the
claim. Also, providers must be properly licensed in their State to
receive payment from CHAMPVA, and they cannot be on the Medicare
exclusion list. To be reimbursed, providers must file a claim, using
diagnosis and procedure codes that all other healthcare plans follow.
The congressional Research Service (CRS) which advises Congress on
programs like this seems to agree. In its October report to Congress on
VA healthcare programs for dependents and survivors, CRS stated,
``CHAMPVA is primarily a health insurance program where certain
eligible dependents and survivors of veterans receive care from private
sector healthcare providers. The program is administered by the
Veterans Health Administration (VHA), Assistant Under Secretary for
Health (AUSH) for Integrated Veteran Care, Office of Integrated Veteran
Care (IVC). The law (38 U.S.C. Sec. of veterans, 1781) requires CHAMPVA
to provide for medical care in the same or similar manner and subject
to the same or similar limitations as medical care is furnished to
certain dependents and survivors of active duty and retired members of
the Armed Forces under [the Department of Defense (DOD) TRICARE
program].'' \1\
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\1\ Health Care for Dependents and Survivors of Veterans, October
16, 2024.
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DOD's TRICARE program wasn't affected by the ACA either, but
Congress created the TRICARE Young Adult program in 2011, which
provides health care for qualified young adults aged 21 to 26 who are
unmarried and not eligible for an employer-sponsored health plan. Our
government should not deem veterans' dependents and survivors less
worthy than civilians for support. Those who are eligible for CHAMPVA
should be able to retain their healthcare coverage until their 26th
birthday just like those in private and Federal healthcare plans. H.R.
1404, the CHAMPVA Children's Care Protection Act, would raise CHAMPVA's
eligibility age to 26, making it consistent with all other Federal and
private plans. We urge Congress to pass this legislation as quickly as
possible.
PVA would once again like to thank the subcommittee for the
opportunity to submit our views on CHAMPVA. We look forward to working
with you on this important issue and would be happy to take any
questions for the record.
Information Required by Rule XI 2(g) of the House of Representatives
Pursuant to Rule XI 2(g) of the House of Representatives, the following
information is provided regarding Federal grants and contracts.
Fiscal Year 2026
Department of Veterans Affairs, Office of National Veterans Sports
Programs & Special Events--Grant to support rehabilitation sports
activities--$368,500.
Fiscal Year 2025
Department of Veterans Affairs, Office of National Veterans Sports
Programs & Special Events----Grant to support rehabilitation sports
activities--$502,000.
Fiscal Year 2023
Department of Veterans Affairs, Office of National Veterans Sports
Programs & Special Events----Grant to support rehabilitation sports
activities--$479,000.
Disclosure of Foreign Payments
Paralyzed Veterans of America is largely supported by donations from
the general public. However, in some very rare cases we receive direct
donations from foreign nationals. In addition, we receive funding from
corporations and foundations which in some cases are U.S. subsidiaries
of non-U.S. companies.
[all]