VA HEALTH-CARE ENROLLMENT PRIORITIES


Eight priority groups have been established to help ensure that VA resources are allocated to veterans with the highest priority for VA care. Priority Group 1 is the highest priority and Priority Group 8 is the lowest. Priority level funding may change from year to year, depending on congressional funding. If VA cannot renew your enrollment for the following year, you will be notified 60 days before your current enrollment period expires. Enrollment for VA health-care will occur based on the following priorities:


Priority Group 1:

  • Veterans with service-connected conditions who are rated 50% or more disabling
  • Veterans determined by VA to be unemployable due to service-connected conditions

Priority Group 2:

  • Veterans with service-connected conditions who are rated 30 or 40 percent disabling

Priority Group 3:

  • Veterans who are Former Prisoners of War (POWs)
  • Veterans awarded the Purple Heart medal
  • Veterans with service-connected disabilities rated 10% or 20% disabling
  • Veterans discharged from active duty for a disability that was incurred or aggravated in the line of duty
  • Veterans awarded special eligibility classification under Title 38, U.S.C., Section 1151, “benefits for individuals disabled by treatment or vocational rehabilitation"

Priority Group 4:

  • Veterans who are receiving aid and attendance or housebound benefits
  • Veterans who have been determined by VA to be catastrophically disabled

Priority Group 5:

  • Nonservice-connected veterans and non-compensable service-connected veterans rated 0% disabled whose annual income and net worth are below the established VA Means Test thresholds
  • Veterans receiving VA pension benefits
  • Veterans eligible for Medicaid programs

Priority Group 6:

  • Compensable 0% percent service-connected veterans
  • World War I and Mexican Border War veterans
  • Veterans seeking care solely for disorders associated with:
    • Exposure to herbicides while serving in Vietnam; or
    • Exposure to ionizing radiation during atmospheric testing or during the occupation of Hiroshima and Nagasaki; or
    • Disorders associated with service Gulf War; or
    • Illness possibly related to participation in Project 112/SHAD
    • Currently enrolled veterans and new enrollees who were discharged from active duty on or after January 28, 2003 are eligible for the enhanced benefits, for 5 years post discharge.
    • Veterans discharged from active duty before January 28, 2003, who apply for enrollment on or after January 28, 2008, are eligible for the enhanced benefit until January 27, 2011.

Priority Group 7:

Veterans who agree to pay specified co-payments with income and/or net worth ABOVE the VA Means Test threshold and income BELOW the geographically based threshold for their locality

  • Sub-priority A: Non-compensable 0% service-connected veterans who are enrolled in the VA health care system on a specified date and who have remained enrolled since that date
  • Sub-priority C: Nonservice-connected veterans who were enrolled in the VA health care system on a specified date and who have remained enrolled since that date
  • Sub-priority E: Non-compensable 0% service-connected veterans not included in Sub-priority-A above
  • Sub-priority G: Nonservice-connected veterans not included in Sub-priority-C above

Priority Group 8:

Veterans who agree to pay specified co-payments with income and/or net worth ABOVE the VA Means Test threshold and income ABOVE the geographically based threshold for their locality

  • Sub-priority A: Non-compensable 0% service-connected veterans enrolled as of January 16, 2003 and who have remained enrolled since that date
  • Sub-priority B: Non-compensable 0% service-connected veterans whose income exceeds the Geographically based threshold by no more than 10% who enrolls after the effective date of Public Law 110-329 (expected in June 2009).
  • Sub-priority C: Non-service-connected veterans enrolled as of January 16, 2003 and who have remained enrolled since that date
  • Sub-priority D: Nonservice-connected veterans whose income exceeds the Geographically based threshold by no more than 10% who enrolls after the effective date of Public Law 110-329 (expected in June 2009).
  • Sub-priority E: Non-compensable 0% service-connected veterans applying for enrollment after January 16, 2003
  • Sub-priority G: Nonservice-connected veterans applying for enrollment after January 16, 2003

NOTE-1: 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.

NOTE-2: VHA Directive 2000-001, dated January 4, 2000 found that ALL blinded veterans will automatically be placed in priority category 4 or higher.

NOTE-3: A veteran who applies for enrollment on or after January 1, 2009 but before the effective date of the new rule, does not qualify for a higher priority group and whose income exceeds the MTT or GMTT by 10% or less will be placed in priority group 8e or 8g and will not be enrolled in the VA health care system. However, the VA Health Eligibility Center will re-determine enrollment using the relaxed income restriction on the effective date of the new provision for those veterans who applied on or after January 1, 2009 and who have been placed in enrollment category 8e or 8g. This approach will relieve veterans from having to submit multiple enrollment applications for the same year. For those veterans who apply on or after January 1, 2009 and are placed into a rejected priority group due to income, VA enrollment correspondence will indicate that VA will re-determine enrollment after the effective date of the new rule.

A Veteran who applied for enrollment prior to January 1, 2009, did not qualify for a higher priority group and whose income exceeded the MTT or GMTT by 10% or less will need to re-enroll for placement in group 8b or 8d.

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