Uncertainty pervades the nation’s healthcare system as we wait for Congress and the Trump administration to come to an agreement on the future of the Affordable Care Act (ACA). While not specifically targeting the veteran population, the ACA provided increased coverage for the nation’s nearly 20 million veterans. An April 2017 Robert Wood Johnson Foundation report found a decline in the number of uninsured veterans across all ages as a result of the passage of the ACA. The largest drops in the uninsured population occurred in those veterans with incomes up to 138% of federal poverty level and were greatest in those states that had expanded Medicaid. The nationwide uninsured rate for veterans fell from 9.6% (close to 1 million people) in 2013 to about 5.9% (552,000) in 2015.
However, despite the drop between 2013 and 2015 resulting from the ACA provisions, in 2015, 730,000 veterans and their families remained uninsured, mainly because they did not meet the income guidelines to qualify for assistance, did not live in an expansion state, or were not enrolled in or did not qualify for Veterans Administration services.
If the proposed changes to the ACA take effect, many veterans who had access to healthcare outside the VA will rely more heavily on the VA for care, even as the federal agency responsible for meeting the healthcare needs of veterans struggle with continued delays in services. In addition, many veterans who gained coverage under the ACA and Medicaid expansion are not eligible for VA benefits.
‘Character of discharge’ and health benefits
Veterans not eligible for VA services comprise a small population of individuals whose military service ended with a discharge that is characterized as “other than honorable.” There is a persistent problem in meeting the needs of veterans who are “other than honorably” discharged and who have a mental health or substance use disorder diagnosis. It is estimated that more than half of those veterans who have been other than honorably discharged have either a mental health or substance use disorder diagnosis or both. This is clearly a fragmented population that runs the risk of falling through the gaps in the healthcare system.
How you can help
There are some steps providers can take to meet the needs of this very important population.
- Provide enrollment eligibility support. Many veterans who fall into this group are homeless. It is essential to determine what types of benefits they do qualify for and to assist them in identifying and enrolling where possible.
- Conduct a comprehensive assessment. This assessment must take into consideration an individual’s experience as a veteran, and identify traumatic brain injury, PTSD, or other mental health issues related to military service. It is essential that providers have the appropriate screening, assessment and diagnostic tools for identifying and addressing the needs of this population.
- Develop specialized training and staffing. It is likely that many providers will need to ensure their staff is adequately trained clinically and culturally to address the unique needs of the veteran population. For example, not all PTSD diagnoses are appropriate for the same kind of PTSD treatment, i.e., PTSD from a car accident or childhood trauma is not the same as PTSD from military duty (requiring some training in cultural relevance). Peer support services have also been found to be most effective in treating the veteran population. Ensuring access to veteran peers to provide support and also ensuring that clinical staff are also veterans can increase the likelihood of success in treating the veteran population.
- Implement specialized supportive services. Employment services and housing services are very important to this population. People are reticent to hire vets, especially those with PTSD. Offering supportive services in a way that is unique to each individual veteran’s needs will be important to ensuring long-term engagement. There is a significant difference between housing a homeless vet and housing a homeless drug user. Understanding the sociology of veterans’ services, including grant and funding opportunities, can provide opportunities for supporting services of which the veteran may not have been aware. Some grants may cover services for those other than honorably discharged.