DATE: September 28, 2007
TO: All Ryan White HIV/AIDS Program Grantees
Attached is the HIV/AIDS Bureau’s (HAB) updated policy describing the Ryan White HIV/AIDS Program and Veterans. This policy was previously published as “Policy Notice 04-01” and was designed to clarify the provision of Ryan White HIV/AIDS Program services to veterans living with HIV who are also eligible for Department of Veterans Affairs (VA) health care benefits. This updated policy reflects the technical changes in Title XXVI of the Public Health Service Act as amended by the Ryan White HIV/AIDS Treatment Modernization Act of 2006 (Ryan White HIV/AIDS Program) and establishes updated guidelines for Ryan White HIV/AIDS Program and Veterans. The previous policy has not undergone any substantive changes and is being re-issued to reflect the technical changes as a result of the newly reauthorized Ryan White HIV/AIDS Program.
The HRSA/HAB policy notice is clear: Ryan White HIV/AIDS Program grantees may not deny services, including prescription drugs, to a veteran who is otherwise eligible for Ryan White HIV/AIDS Program services. The updated Frequently Asked Questions (FAQs) clarify specific issues raised about the policy and provide information about resources available to veterans in the VA health care system and have also been included with the updated policy.
Many Ryan White HIV/AIDS Program grantees already have a long standing relationship with the VA, their local VA health care facility and enrollment office. If you do not, HRSA encourages you to meet with VA staff and providers, learn more about VA’s health care eligibility and enrollment, and services provided to HIV-infected veterans in order to have optimal Ryan White HIV/AIDS Program and veterans coordination.
For additional information about other VA benefits eligibility, including housing, education and training, vocational rehabilitation and employment benefits and services for homeless veterans check the Veterans Administration Web site or contact a VA benefits office at 1-877-222-VETS. Each year the VA publishes and updates the Federal Benefits for Veterans and Dependents pamphlet.
If you have any questions regarding the content of the HAB Policy Notice, please contact your project officer. Thank you for your attention to this important matter.
Deborah Parham Hopson, Ph.D., R.N.
Assistant Surgeon General
The Bureau developed this policy:
To explain how the coordination of care for veterans who are eligible for Ryan White HIV/AIDS Program services can be maximized;
VA Health Care:
Like most systems of health care in the U.S., the VA health care system has changed significantly. In recent years, the Congress made legislative changes that have dramatically enhanced veterans’ health care benefits as well as access to those benefits. The VA administers its program through a system of annual patient enrollment. The enrollment system assigns veterans to priority groups to ensure that health care benefits are available to enrolled veterans. The eight (8) enrollment priority groups can be found in Attachment 1.
The Secretary of the VA makes a determination about the level at which VA will enroll the eight priority groups. Since January 2003, for example, the VA is accepting no new Priority Group 8 veterans for enrollment. Because these groups are subject to change, Ryan White HIV/AIDS Program grantees should periodically visit the VA Web site to confirm the current priority group categories that VA is currently enrolling.
Veterans receiving care through the VA are eligible for VA's medical benefits package which includes:
Veterans must meet certain eligibility criteria for some services. For example, to qualify for eyeglasses a veteran must have a VA service-connected disability rating of 10 percent or meet other criteria, such as being so severely visually impaired that eyeglasses are necessary to permit them to participate in their care. Even with these limitations for certain services, the VA provides comprehensive direct care for veterans. A veteran may select any VA health care facility to serve as their primary treatment facility. Congress added geographically-based means testing in addition to the existing VA national income thresholds for financial assessment purposes, effective October 1, 2002 (See Attachment 1 for the VA Web site that contains the current means test thresholds).
While many veterans qualify for enrollment and cost-free health care services based on a compensable service-connected condition or other qualifying factor, most veterans will be asked to complete a financial assessment as part of their enrollment application process. Co-payments for outpatient medical care and/or pharmaceuticals may be required from veterans in some priority groups, primarily those without service connected disability and higher income levels.
Because the VA, like the Ryan White HIV/AIDS Program and other programs, depends primarily on annual Congressional appropriations, the VA encourages veterans to retain any health care coverage they may already have, especially those veterans in the lower enrollment priority groups. There is no guarantee that Congress will appropriate sufficient funds for VA to provide care for all enrollment priority groups. VA’s general treatment authority (38 U.S.C. §1710) does not include payer of last resort language and VA health care is not an entitlement program. Veterans with private health insurance or with federally-funded coverage through the Department of Defense (TRICARE), Medicare, or Medicaid, may choose to use these sources of coverage as a supplement to or an alternative to their VA benefits.
By law, the VA bills health insurers for services provided to treat non-service-connected conditions. To ensure that current insurance information is on file, including coverage through employment or through a spouse, the VA asks about the veteran’s health insurance coverage during each patient visit.
Ryan White HIV/AIDS Program and Veterans:
All enrolled veterans may choose to receive their care from the VA health care system. However, even if enrolled for VA health care, a veteran does not have to use the VA as their exclusive health care provider. Veterans are never required to access their health care services from the VA, but rather they are always free to obtain their health care services from the provider of their choice. Veterans with private health insurance may elect to use those benefits in seeking services from non-VA providers as a supplement to their VA care. VA is not, however, an insurance plan or an entitlement program and the VA authority to pay for services from individual non-VA providers is extremely limited.
In addition, veterans may enroll in other private or public programs including Medicare, Medicaid, and may receive services paid for by the Ryan White HIV/AIDS Program . To ensure that veterans have full access to all possible services, and to ensure that veterans are obtaining their preferred services, Ryan White HIV/AIDS Program grantees and contractors should inform HIV-infected veterans of the benefits, services, and physical location of the VA in their area. Many veterans have not enrolled or used a VA facility and may not know what the current requirements are for the eight priority groups. Ryan White HIV/AIDS Program grantees are required to work with their local VA HIV/AIDS coordinators who are available for coordination, enrollment, and questions. Ryan White HIV/AIDS Program grantees may obtain the name and contact information of their local VA facility HIV/AIDS Coordinators from Ms. Donna Wells (firstname.lastname@example.org or (202) 461-7250).
Ryan White HIV/AIDS Program grantees or contractors may not deny services, including prescription drugs, to a veteran who is otherwise eligible for Ryan White HIV/AIDS Program services. Ryan White HIV/AIDS Program grantees may not cite the “payer of last resort” language in Section 2605(a)(6), 2617(b)(7)(F), or 2664(f) of the Public Health Service Act to force an HIV-infected eligible veteran to obtain services from the VA health care system or refuse to provide services. Services can be refused on the same basis as decisions of refusal for non-veterans.
Some VA facilities do not have infectious disease specialists or HIV/AIDS experienced providers. Ryan White HIV/AIDS Program providers are required to be familiar with the VA facilities in their local areas that have this expertise and which ones do not. Ryan White HIV/AIDS program providers need to determine where the VA facilities are located; referrals to VA facilities that are located outside an acceptable range are not required.
VA Health Care Enrollment Priority Groups
Upon receipt of a completed application (must include signature and date), the veteran’s eligibility will be verified. Based on his/her specific eligibility status, he/she will be assigned to one of the following VA priority groups. The groups range from 1 through 8 with Priority Group 1 being the highest priority and Priority 8 the lowest.
Priority Group 1:
Priority Group 2:
Priority Group 3:
Priority Group 4:
Priority Group 5:
Priority Group 6:
Priority Group 7:
Priority Group 8:
**Note: Veterans assigned to Priority Groups 8e or 8g are not eligible for enrollment as a result of the enrollment restriction which suspended enrolling new high-income veterans who apply for care after January 16, 2003. Veterans enrolled in Priority Groups 8a or 8c will remain enrolled and eligible for the full-range of VA health care benefits.
[Priority Groups 7 and 8 both have subpriority groups, a, c, e, and g that are in descending order based on highest to lowest priority. They deliberately were not placed in consecutive order. Since these designations are used exclusively for internal VA tracking purposes, the VA reserved b, d, and f for future use in the event of additional changes in the priority groups.]
For more information from the Veterans Administration, please look at the VA web site
For information on enrollment in VA’s health care system, including co-payments and both the geographic means test thresholds and Veterans Health Administration means test thresholds.
Specific questions can be answered by your local VA health care facility’s enrollment office or the Veterans Health Benefits Service Center at 1-877-222-VETS (1-877-222-8387).