Putting Families First: Strengthening CHAMPVA for Survivors and Dependents

1[House Hearing, 119 Congress]2[From the U.S. Government Publishing Office]34                        PUTTING FAMILIES FIRST:5                       STRENGTHENING CHAMPVA FOR6                        SURVIVORS AND DEPENDENTS7=======================================================================89                                HEARING1011                               BEFORE THE1213                         SUBCOMMITTEE ON HEALTH1415                                 OF THE1617                     COMMITTEE ON VETERANS' AFFAIRS1819                     U.S. HOUSE OF REPRESENTATIVES2021                    ONE HUNDRED NINETEENTH CONGRESS2223                             FIRST SESSION2425                               __________2627                      WEDNESDAY, DECEMBER 10, 20252829                               __________3031                           Serial No. 119-393233                               __________3435       Printed for the use of the Committee on Veterans' Affairs3637[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]3839                    Available via http://govinfo.gov4041                                __________4243                   U.S. GOVERNMENT PUBLISHING OFFICE4463-814                    WASHINGTON : 202645=======================================================================4647                     COMMITTEE ON VETERANS' AFFAIRS4849                     MIKE BOST, Illinois, Chairman5051AUMUA AMATA COLEMAN RADEWAGEN,       MARK TAKANO, California, Ranking52    American Samoa, Vice-Chairwoman      Member53JACK BERGMAN, Michigan               JULIA BROWNLEY, California54NANCY MACE, South Carolina           CHRIS PAPPAS, New Hampshire55MARIANNETTE MILLER-MEEKS, Iowa       SHEILA CHERFILUS-MCCORMICK,56GREGORY F. MURPHY, North Carolina        Florida57DERRICK VAN ORDEN, Wisconsin         MORGAN MCGARVEY, Kentucky58MORGAN LUTTRELL, Texas               DELIA RAMIREZ, Illinois59JUAN CISCOMANI, Arizona              NIKKI BUDZINSKI, Illinois60KEITH SELF, Texas                    TIMOTHY M. KENNEDY, New York61JEN KIGGANS, Virginia                MAXINE DEXTER, Oregon62ABE HAMADEH, Arizona                 HERB CONAWAY, New Jersey63KIMBERLYN KING-HINDS, Northern       KELLY MORRISON, Minnesota64    Mariana Islands65TOM BARRETT, Michigan6667                       Jon Clark, Staff Director68                  Matt Reel, Democratic Staff Director6970                         SUBCOMMITTEE ON HEALTH7172               MARIANNETTE MILLER-MEEKS, Iowa, Chairwoman7374JACK BERGMAN, Michigan               JULIA BROWNLEY, California,75GREGORY F. MURPHY, North Carolina        Ranking Member76DERRICK VAN ORDEN, Wisconsin         SHEILA CHERFILUS-MCCORMICK,77JEN KIGGANS, Virginia                    Florida78ABE HAMADEH, Arizona                 MAXINE DEXTER, Oregon79KIMBERLYN KING-HINDS, Northern       HERB CONAWAY, New Jersey80    Mariana Islands                  KELLY MORRISON, Minnesota8182Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public83hearing records of the Committee on Veterans' Affairs are also84published in electronic form. The printed hearing record remains the85official version. Because electronic submissions are used to prepare86both printed and electronic versions of the hearing record, the process87of converting between various electronic formats may introduce88unintentional errors or omissions. Such occurrences are inherent in the89current publication process and should diminish as the process is90further refined.91                         C  O  N  T  E  N  T  S9293                              ----------9495                      WEDNESDAY, DECEMBER 10, 20259697                                                                   Page9899                           OPENING STATEMENTS100101The Honorable Mariannette Miller-Meeks, Chairwoman...............     1102The Honorable Julia Brownley, Ranking Member.....................     3103104                               WITNESSES105                                Panel I106107Dr. Maria Llorente, MD, Acting Assistant Under Secretary for108  Health, Office of Integrated Veteran Care, U.S. Department of109  Veterans Affairs...............................................     5110111        Accompanied by:112113    Mr. David Fennell, Director, Veteran and Family Member114        Programs, Integrated External Networks, Office of115        Integrated Veteran Care, U.S. Department of Veterans116        Affairs117118Mrs. Caira Benson, Veteran Support & Strategic Initiatives119  Specialist, Code of Support Foundation.........................     6120121Mr. James Zenner, National Policy Director, National Association122  of County Veteran Service Officers.............................     8123124                                APPENDIX125                    Prepared Statements Of Witnesses126127Dr. Maria Llorente, MD Prepared Statement........................    25128Mrs. Caira Benson Prepared Statement.............................    26129Mr. James Zenner Prepared Statement..............................    28130131                       Statements For The Record132133Questions for the Record Submitted by The Honorable Marianette134  Miller-Meeks, U.S. House of Representatives, (IA-01)...........    31135Response to Questions for the Record Submitted by Caira Benson...    36136Response to Questions for the Record Submitted by U.S. Department137  of Veterans Affairs............................................    39138Response to Questions for the Record Submitted by National139  Association of County Veterans Service Officers................    49140Paralyzed Veterans of America Prepared Statement.................    56141142                        PUTTING FAMILIES FIRST:143                       STRENGTHENING CHAMPVA FOR144                        SURVIVORS AND DEPENDENTS145146                              ----------147148                      WEDNESDAY, DECEMBER 10, 2025149150                    Subcommittee on Health,151                    Committee on Veterans' Affairs,152                             U.S. House of Representatives,153                                                    Washington, DC.154    The subcommittee met, pursuant to notice, at 3:38 p.m., in155room 360, Cannon House Office Building, Hon. Mariannette156Miller-Meek [chairwoman of the subcommittee] presiding.157    Present: Representatives Miller-Meek, King-Hinds, Kiggans,158Brownley, Cherfilus-McCormick, Dexter, and Conaway.159160   OPENING STATEMENT OF MARIANNETTE MILLER-MEEKS, CHAIRWOMAN161162    Ms. Miller-Meeks. The Subcommittee on Health will now come163to order. The chair may declare recess at any point. That was164when we were anticipating votes.165    I would like to welcome all the members and the witnesses166to today's hearing. Many here today have likely heard that the167U.S. Department of Veterans Affairs (VA) has taken significant168steps to improve the Civilian Health and Medical Program of the169Department of Veterans Affairs, CHAMPVA. CHAMPVA is a program170to provide earned benefits for veterans' families whenever the171veteran has qualifying service-connected disabilities or death.172A veteran spouse or child can access a range of covered health173services through CHAMPVA, inpatient and outpatient care,174prescription drugs, mental health services, skilled nursing175care, and others.176    CHAMPVA is a way that we honor our commitment to serving177the veterans and their families who are injured in the line of178duty. Sometimes circumstances require that family members179forego a full-time job with health insurance benefits so they180can care for their veteran full time instead. These caregivers181consider CHAMPVA a lifeline.182    Decades ago, Congress created CHAMPVA to close a gap left183by TRICARE. CHAMPVA, when it works, is a huge relief for184veterans and their families. Affordability is on everyone's185mind and that is especially true for veteran families with186serious medical needs. Fortunately, the VA has recently taken187steps to ensure CHAMPVA works. I am pleased that the Trump188administration is pulling out all the stops to bring down the189cost of living by putting families first.190    Just before Thanksgiving, Secretary Collins announced the191elimination of CHAMPVA application backlog. That is over 60,000192more families who can now access caregiver healthcare benefits193at the VA.194    The subcommittee appreciates the VA's work to modernize195CHAMPVA. Online applications and claims should have been196available a long time ago, but if we continue to hold the VA197accountable, veterans and their families will see greater198results.199    As a case in point, I am particularly pleased that the VA200is in the process of developing a CHAMPVA Provider Directory.201This is after an abundance of feedback from Members of Congress202to the VA about the difficulty that beneficiaries have even203finding someone who will accept CHAMPVA. The committee has been204diligent in exploring solutions for a provider directory. I205want to thank my friend and colleague, Oversight Committee206Chairwoman Jen Kiggins for her leadership on this issue as she207recently wrote a letter and introduced legislation to create208this system for veterans and their families. Needless to say,209we will continue to exercise oversight to ensure that the210CHAMPVA Directory is fully implemented.211    Modernization like this and CHAMPVA's ongoing efforts212enhances the convenience of using the CHAMPVA program, and now213VA can process applications and claims faster than they have in214the past. I am encouraged that the VA is now aiming to process215100 percent of electronic claims within 30 days. It should be216noted that in the past, their stretch goal was to process 90217percent of electronic claims in that time.218    However, there are still obstacles and opportunities for219this program. Navigating VA bureaucracy is never easy. I have220heard that certain obstacles remain in CHAMPVA, and I expect221our witnesses to highlight these issues today.222    Foremost, this subcommittee will do its part so that the VA223can process 100 percent of all claims within 30 days, not only224the electronic ones. Paper claims still take too long to225process. I know delays are inherent and manual processing is226tedious, but I look forward to working with the VA to speed up227paper processing as well.228    Second, there is limited transparency for status updates on229applications or claims requests. Spouses and children want to230know what is going on with your application. Caregivers and231providers want to know whether their claims will be accepted or232denied. Whenever they hear radio silence from the VA, they lose233trust in the VA.234    This subcommittee spoke with one large healthcare provider235who shared that the VA assigned a direct representative to236address their claims questions. The direct representative was237too overwhelmed to ever timely resolve the provider's238questions. The provider would have to wait months just to get239questions answered. Speaking as a veteran and a provider, I240want to ensure this provider's experience is a thing of the241past. There must be a better way to get information for242families and providers so they know exactly what their benefits243are ahead of time.244    Third, the VA could resolve claims faster if it improved245its ability to cross-reference a spouse or a child's health246insurance and whether that person reached his or her247deductible. Because CHAMPVA can function as either a primary or248a secondary payer, providers must properly bill either the249program or somebody else's health insurance first.250Unfortunately, this coordination frequently breaks down and251providers lose time filing the claim, only for the VA to252require a different form.253    It is also important to know in real-time whether a spouse254or child has reached the deductible. Right now, real-time255knowledge is unavailable to claims processors. I would like to256see that change.257    Last, some aspects of the CHAMPVA process create snags for258caregivers that limit the program's use. The subcommittee has259heard most about the fact that CHAMPVA identification cards260are, in fact, not cards. They are strips of paper. Mrs. Benson261so clearly explained the issue when she showed this262subcommittee her own card. She explained that if anything263happens to the card, meaning paper strip, like if somebody264accidentally spills a drink on it, it has never happened to265anybody in this committee or in the audience, the caregiver266must wait for another strip of paper from the VA. Caregivers267should not have to ask their neighbor for a laminator to avoid268damage or destruction to their healthcare paperwork.269    I hope this discussion sheds light on these concerns and270opens the door to further discussions on how we continue to271modernize CHAMPVA and have it work better for veterans and272their caregivers.273    Just like every other American family, veteran families274with caregiving responsibilities set aside this time of year to275give their thanks to God, celebrate one another, and enjoy276tradition. Caregivers must also balance the healthcare demands277to ensure that they and their loved ones in need enjoy the278season to the fullest. Our goal with this hearing is to make279CHAMPVA work as it is intended to serve veterans families.280    Finally, I would like to thank beneficiaries, like Mrs.281Benson and many others from groups like Senator Elizabeth282Dole's foundation, for sharing their stories and bringing283CHAMPVA's issues to us.284    I now yield to Ranking Member Brownley for any open remarks285she may have.286287      OPENING STATEMENT OF JULIA BROWNLEY, RANKING MEMBER288289    Ms. Brownley. Thank you, Madame Chair. Thank you to our290witnesses for being here today and apologize for the waiting291that you had to undergo. I am glad to have an opportunity to292examine the CHAMPVA program and the significant opportunities293for improvement in VA's administration of this program.294    I would first like to note that the committee staff have295not received a briefing from VA's Office of Integrated Veteran296Care (IVC) since December 2024, a whole year ago. I hope you297agree, Madame Chair, that this is wildly unacceptable,298especially considering this office is responsible for299administering community care programs that account for more300than $40 billion per year in VA expenditures. Committee staff301used to receive briefings from this office every other month. I302am very concerned that under the Trump administration, these303briefings have completely stopped.304    CHAMPVA is just one of the programs the Office of305Integrated Veteran Care administers, and it is my understanding306that they were working on a number of initiatives to improve307this program throughout 2024, but we have received no updates308in nearly a year.309    I am glad VA officials are here today to share their recent310progress, but it is clear from our other witnesses' testimony311that far more remains to be done and we need more regular312oversight of CHAMPVA program. Whether it is the lack of online313self-service tools for applicants, enrollees, and providers,314the lack of a formal provider network or online provider315directory, or the lack of transparency for beneficiaries and316providers about allowable payment rates, there are many ways317that CHAMPVA could work better for beneficiaries and providers.318    As many of you know, I have long been a proponent of319reforms for CHAMPVA. I strongly believe my legislation to allow320dependents to remain enrolled until they turn 26, regardless of321school enrollment, is necessary to ensure parity between322CHAMPVA and most Other Health Insurance (OHI) plans. However,323in previous testimony about my CHAMPVA bill, VA indicated that324it does not view CHAMPVA as an insurance plan, but as a medical325care benefit. As I said, then, if it walks like a duck and326swims like a duck and quacks like a duck, it is probably a327duck. CHAMPVA has copays, annual deductibles, and maximum out-328of-pocket costs. It has a formulary. CHAMPVA requires prior329authorization for certain services. It counts as minimum330essential coverage under the Affordable Care Act (ACA). If that331is not health insurance, I do not know what it is.332    VA needs to decide if it wants to continue to force333caregivers and families of veterans to navigate a system that334has all of the complexities and frustrations of health335insurance and places all the burden of navigating that system336on beneficiaries, or if it wants to provide the loved ones of337fallen and severely injured servicemembers and their caregivers338of our most vulnerable veterans with the best support and339healthcare benefits possible. That is my choice.340    Mrs. Benson, I am glad we have you here today to speak341about your own experiences as well as your work with the Code342of Support Foundation, helping other families and caregivers343navigate the system. It is clear from your testimony that you344are well-versed in this program and how to navigate it. VA345should not be reliant on beneficiaries to recruit providers,346determine what codes will allow VA to process claims, and know347every step of a complex appeals process. The way the system is348currently set up, it seems you need endless hours of free time349and the equivalent of a Ph.D. in health insurance just to make350sure your family can get covered for the care you need. This351obviously is not acceptable.352    I believe it is clear to everyone in this room that there353is massive room for improvement in the CHAMPVA program. This354hearing is a good step at providing insight and oversight. I355hope it will not end here.356    I thank you and, Madame Chair, thank you for the hearing,357and I yield back.358    Ms. Miller-Meeks. Thank you, Ranking Member Brownley.359    I would now like to introduce our witnesses who have been360very patient through this process. Thank you again.361    Testifying before us today, we have Dr. Maria Llorente,362acting assistant under secretary for health at the Office of363Integrated Veteran Care at the VA. She is supported by Mr.364David Fennell, director of veteran and family member programs,365including CHAMPVA. Mrs. Caira Benson, veteran support and366strategic initiatives specialist at the Code of Support367Foundation. She is also a CHAMPVA beneficiary. Mr. Jim Zenner,368excuse me, national policy director for the National369Association of County Veteran Service Officers.370    Dr. Llorente, you are now recognized for 5 minutes to371present your testimony.372373                  STATEMENT OF MARIA LLORENTE374375    Dr. Llorente. Thank you. Chairwoman Miller-Meeks, Ranking376Member Brownley, and distinguished members of the subcommittee,377thank you for the opportunity to testify today about the378Civilian and Medical Program of the Department of Veterans379Affairs, or CHAMPVA, a vital program that provides healthcare380coverage to eligible spouses, children, survivors, and381caregivers of qualifying veterans. Joining me today is Mr.382David Fennell. He is the director of veteran and family member383programs in the Office of Integrated Veteran Care.384    CHAMPVA plays a critical role in supporting the families of385veterans who have made profound sacrifices in service to our386Nation. My testimony today will provide an overview of the387program's eligibility criteria, current operations, recent388improvements, and opportunities for continued collaboration389with Congress to ensure timely, efficient, and equitable access390to care. Authorized under the United States Code Title 38,391Section 1781, CHAMPVA provides healthcare coverage to eligible392spouses, surviving spouses, and children of veterans who are393permanently and totally disabled due to a service-connected394disability or who died as a result of a service-connected395condition or who died while rated permanently and totally396disabled from a service-connected condition. It also covers397certain survivors of members who died in the line of duty and398certain primary family caregivers under the program of399Comprehensive Assistance for Family Caregivers.400    To be eligible for CHAMPVA, the individual cannot be401eligible for TRICARE. As of November 2025, CHAMPVA provides402healthcare coverage to more than a million beneficiaries. The403program receives approximately 4,000 new applications every404week, and more than 90 percent of medical and pharmacy claims405are now processed electronically within days of receipt,406ensuring timely reimbursement and continuity of care.407    Under the leadership of Secretary Collins, and thanks to408recent reforms, the application backlog, previously exceeding40970,000 cases, has been eliminated. New applications are now410processed in a matter of days. The appeals backlog has also411been reduced from over 20,000 to approximately 1,000 with412continued progress underway. These improvements reflect413Department of Veterans Affairs' commitment to veteran first414service delivery, accountability, and efficiency.415    Under the last administration, CHAMPVA faced significant416delays in application and appeals processing due to increased417demand, staffing constraints, and reliance on legacy manual418systems. Some applicants waited over 150 days for419determinations. Under Secretary Collins' leadership, VA420implemented a two-pronged strategy: authorizing overtime for421application processors and introducing enhanced process422engineering and new automation to streamline workflows. These423actions have assured timely access to benefits for eligible424CHAMPVA beneficiaries.425    VA is modernizing CHAMPVA operations to reduce bureaucracy426and improve the user experience. In December 2025, we will427complete the transition to a more automated application428processing system, increasing efficiency and reducing manual429workload. These efforts align with VA's broader digital430transformation strategies and support the Department's goals of431transparency, reduced administrative burden, and improved432outcomes for veterans and beneficiaries.433    Access to accurate provider information is another area of434focus. Although CHAMPVA beneficiaries may see any provider who435accepts CHAMPVA's allowable rates, VA acknowledges that436beneficiaries may experience difficulty identifying437participating providers or confirming whether a provider is438accepting new patients. We are working to improve how provider439information is presented and maintained, including updating440publicly available guidance and strengthening communication441with providers who build CHAMPVA.442    We appreciate the continued interest in strengthening443CHAMPVA. Over the last few months, VA has made significant444strides in eliminating backlogs, modernizing systems, and445improving access. We remain focused on delivering timely, high-446quality service to those who have sacrificed so much.447    This concludes my statement and we look forward to448responding to any questions that you may have.449450    [The Prepared Statement Of Maria Llorente Appears In The451Appendix]452453    Ms. Miller-Meeks. Thank you, Dr. Llorente.454    Mrs. Benson, you are now recognized for 5 minutes to455present your testimony.456457                   STATEMENT OF CAIRA BENSON458459    Mrs. Benson. Chairwoman Miller-Meeks, Ranking Member460Brownley, and members of the House Veterans' Affairs461Subcommittee on Health, thank you for inviting me to testify462today. It is my honor to return to further the discussion on463the inefficiencies and inequalities within the Department of464Veterans Affairs CHAMPVA Program.465    At the Code of Support Foundation we work with veterans and466their families every day. Our digital resource hub,467PATRIOTlink, has served over 67,000 military community members468to find needed supports and resources. Our case management team469has already worked with over 1,300 family members this year to470navigate local, regional, national, and government partners to471achieve stability through needed financial, social, physical472health, and mental health supports. I am not just here as an473employee. I am here as a caregiver and advocate and Elizabeth474Dole Foundation fellow alum and a CHAMPVA user.475    I care for my husband, who deployed twice to Iraq as a476combat engineer between 2003 and 2006. My husband suffered477multiple traumatic brain injuries during his years of service,478complicated by toxic encephalopathic process, most likely due479to chemical exposure. My five children and I enrolled in480CHAMPVA in 2017, when my husband was awarded permanent total481status for service-connected injuries. We breathed a sigh of482relief knowing that we would have the safety net of healthcare483for myself and our children, three of whom have needed484specialty medical care through the years.485    I testified in June of this year to this subcommittee about486the nightmare navigating CHAMPVA has been for our family.487Highlights of that nightmare include having to sign a $110,000488promissory note to ensure a needed hospitalization occurred in489the chance that CHAMPVA refused payment and being sent to490collections when CHAMPVA claims payments did not occur in a491timely manner, with one provider waiting over 27 months for492payment. CHAMPVA's appropriate care has felt anything but493appropriate.494    I will not rehash my earlier testimony. I know the495committee is interested in how the situation looks for CHAMPVA496today, if changes have been made, and how those changes have497been received since my last testimony.498    I commend VA for finally clearing the CHAMPVA application499backlog. It is beyond time to process applications in real500time.501    I was also overjoyed to hear that claims being submitted502electronically are being paid quicker than previously. Yet even503with that good news, the situation on the ground for CHAMPVA504users remains murky. While the application backlog is cleared,505only two families I know waiting on their decisions have506received notifications of such to date.507    Provider acceptance of CHAMPVA still remains a challenge. I508had a medical complication this year which required me to509travel over an hour for outpatient procedures as they were the510nearest willing provider to file. I still pay out of pocket for511my children's mental health providers as we have yet to find a512provider who accepts CHAMPVA mental health for kids.513    I know I am not alone. At Code of Support one of our most514frequent requests is mental health supports for dependents. We515have multiple national and regional providers we work with for516those supports. Five take TRICARE and refuse to take CHAMPVA.517To quote one, VA is too difficult to work with.518    It is hard to place blame on the providers for declining519CHAMPVA . Indeed, VA has made it difficult on providers filing520claims and on users looking for providers. Lack of a provider521network and published fee schedules, unclear claims filing522processes, and varied claims payment times contribute to the523difficulties. Appeals for denied coverage under CHAMPVA are524difficult to navigate as well.525    A CHAMPVA enrollee recently had her child's claim for an526ambulance ride during an anaphylaxis event denied. It took us527an hour of digging through claims denial letters, Explanation528of Benefits (EOB), and Current Procedural Terminology (CPT)529codes to understand what had happened. The denial was due to530inaccurate billing codes. While we do not believe the CHAMPVA531enrollee will be charged for the ambulance ride, the denial532letter listed three appellate structures, none of them the533Clinical Appeal option listed on the CHAMPVA website. None of534them offered an option for a third party review, something that535was considered routine in today's world of denied insurance536claims.537    As they did in the Senate Veterans Affairs Committee on May53821, 2025, VA has argued in the past that CHAMPVA is not an539insurance product, it is a medical service. I remain steadfast.540The industry, the Federal Government, and, more often than not,541VA itself treats CHAMPVA as an insurance product. If we choose542to shop for insurance through Healthcare Marketplace, CHAMPVA543enrollees are not eligible for financial assistance nor544advanced premium tax credits.545    Every year, CHAMPVA enrollees receive a 1095B attesting to546the fact that CHAMPVA accounts for minimal essential coverage547under the Affordable Care Act. Finally, even VA states that548CHAMPVA is only available to caregivers in the VA's Program for549Comprehensive Assistance to Family Caregivers when they have no550other health insurance. Thus, CHAMPVA identifies itself as an551insurance plan when it offers proof of coverage and bars use of552its plans in the face of other coverage.553    Indeed, the stance that CHAMPVA is not an insurance product554is detrimental to veterans families. At Codes of Support I555recently walked a disabled veteran through enrollment for his556wife into CHAMPVA. Prior to reaching out to us, the veteran had557purchased insurance for his dependent, causing a financial558burden through the Healthcare Marketplace, not understanding559that CHAMPVA provided ACA compliant coverage.560    In short, CHAMPVA remains a complicated mess for users.561While VA has announced positive steps to easing some of these562known problems, CHAMPVA fixes are far from complete. CHAMPVA563users need statutory change and regulatory clarity, mandated564electronic claims filings, and claims--and clarity in claims565appeals processes, including a third party review.566    In VA's mission to fulfill President Lincoln's promise to567care for those who have served for our Nation's military and568for their families, caregivers, and survivors, CHAMPVA is569failing. As a community we cannot continue to allow this570egregious lapse of coverage for those who need it most.571    I thank you for your time and I look forward to your572questions.573574    [The Prepared Statement Of Caira Benson Appears In The575Appendix]576577    Ms. Miller-Meeks. Thank you, Mrs. Benson.578    I now recognize Mr. Zenner for his opening testimony for 5579minutes.580581                   STATEMENT OF JAMES ZENNER582583    Mr. Zenner. Chairwoman Miller-Meeks and Ranking Member584Brownley, distinguished members of the committee, thank you for585the opportunity to appear before you today on behalf of the586National Association of County Veteran Service Officers. N-A-C-587V-S-O or NAC-V-S-O represents the government-employed588accredited advocates who help veterans and their families589access the benefits that they have earned.590    First, I want to express our sincere appreciation to the591CHAMPVA staff for their extraordinary progress in reducing the592application backlog. We are hearing reports of applications593being processed on average of 10 days and in some as few as 4.594That is not simply an administrative improvement, it is timely595access to healthcare for eligible dependents and we thank the596teams responsible for this achievement.597    Today I want to highlight several practical refinements598that would increase accessibility and efficiency for CHAMPVA599families and the Government Veteran Service Officers (GVSO) who600serve them. Our first recommendation is modernizing the CHAMPVA601application process. Right now, GVSOs cannot submit CHAMPVA602applications electronically. They must print, complete, and603then fax or mail them, which prevents confirmation of receipt,604prevents tracking, and makes it difficult to provide updates to605families.606    Meanwhile, many dependents cannot use VA.gov. The digital607submission workflow similar to the Veterans Benefits608Administration's (VBA) National Work Queue would allow609electronic submission, real-time status updates, and reduce610burden on CHAMPVA staff. Additionally, expanding the VA Form61121-22 authority to include Veterans Health Administration (VHA)612and CHAMPVA would allow accredited officers to communicate with613CHAMPVA staff directly, speeding resolution of issues for614families.615    Our second recommendation is expanding provider awareness616and participation. Across the country many community providers617do not know what CHAMPVA is, who it covers, and how the billing618works. Some confuse it with TRICARE or VA Community Care, and619this creates avoidable access barriers. Targeted education620campaigns, provider toolkits, inclusion and electronic billing621systems, and partnerships with medical associations would622meaningfully expand access for spouses, dependents, and623caregivers.624    Third, we recommend redesigning CHAMPVA identification625cards. Providers frequently mistake the CHAMPVA card for the626Community Care card and, in some cases, dependents have been627turned away. A distinct and easily recognizable card would628reduce confusion and improve the care experience.629    Finally, we urge the committee to address the coverage gap630for dependent students turning 18. Under current policy,631CHAMPVA eligibility elapses until school enrollment is632verified, a process that often takes 8 to 9 months. During this633time, dependents incur medical costs out of pocket, claims are634lost or forgotten, and families face unnecessary stress despite635the fact that VBA has already determined the underlying636eligibility. Provisional continued coverage, automated637verification with schools, online certification at VA.gov and638pre-verification notices would significantly reduce this639burden.640    CHAMPVA is a very strong program and recent progress641demonstrates VA commitment to families of those who have642served, but continued refinement is both necessary and643achievable. Government Veterans Service Officers stand ready to644assist VA and this committee in improving processes, expanding645access, and ensuring that eligible family members receive646timely, reliable health coverage.647    Thank you for your leadership and thank you for the648opportunity to testify today. I am happy to answer any649questions. Thank you.650651    [The Prepared Statement Of James Zenner Appears In The652Appendix]653654    Ms. Miller-Meeks. Thank you very much, Mr. Zenner.655    As is my typical practice, I will reserve my time until all656of the members have had a chance to ask their questions.657    I now recognize Ranking Member Brownley for 5 minutes for658any questions she may have.659    Ms. Brownley. Thank you, Madame Chair.660    My first question is to Ms. Llorente. Thank you for being661here. We know based on Mrs. Benson's testimony that even662despite VA's recent elimination of the application backlog, and663that is a good first step, I want to acknowledge that, that is664a good first step, but many families are still waiting to know665the status of their applications and their school enrollment666certifications. The only way for them, the way I understand it,667is to check their status is to call the call center, the668CHAMPVA call center. Do you know what the average wait time is669to talk to someone on the other end of the call center?670    Dr. Llorente. Yes, ma'am. Thank you. It can vary based on671the time of day, the day of week. In some cases, it could be as672little as 5 to 10 minutes. In other cases, it could be as long673as several hours.674    Ms. Brownley. As long as how many?675    Dr. Llorente. Several hours.676    Ms. Brownley. Several hours.677    Dr. Llorente. Yes. We do have a callback feature that is678part of the call center, but it is not acceptable.679    Ms. Brownley. Well, I know the committee staff called the680service line four times and all four times there was a message681saying that the wait time would be over 2 hours. Not 2 hours,682but over 2 hours. Why--I mean, that seems like an easy problem683to solve and I do not know why it is not being solved.684    I mean, it is great to, you know, attack the backlog. That685is great. If people cannot get finality to the situation, that686is not great. This, you know, waiting more than 2 hours for687folks can be pretty frustrating.688    Dr. Llorente. Yes, ma'am, I agree with you. We are taking a689series of steps in order to address the issue. I wish that it690was an easy problem to solve because please be assured, if it691was, it would have been solved.692    Some of the various steps that we are in the process of693taking are looking at our workflows, standardizing some of the694workflows. We have also begun leveraging additional contractor695support. We do have a contractor with whom we work that assists696in surging and answering the call center.697    A very important step that we are working on conducting is698being able to do online status verification so that there would699not even be a need for, for a phone call. The veteran and/or700the beneficiary would be able to check online and be able to701see the status of their application, the status of their claim.702We are planning to be able to do that in 2026. Efforts are703underway. These are some of the steps that we are taking.704    Ms. Brownley. Okay. Until that program happens, if somebody705is waiting over 2 hours to talk to a live human being, their706issue has not been resolved, then do they just have to say707thank you very much and try next week and go through the same708exercise, or do you prioritize that person and call them back709with a resolution to what the issue is so that they do not have710to continually go through this horrendous process?711    Dr. Llorente. Yes, that is one of the features that are712part of our call centers. We are able to call the veteran and/713or the beneficiary back.714    Ms. Brownley. Okay. Mrs. Benson, so, again, thank you for715being here. You have been quite helpful to us looking into this716process, so really appreciate your time and focus on this.717    In your testimony, you discussed how difficult it has been718to find pediatricians and mental healthcare providers willing719to accept the CHAMPVA payment. I know you talked about, you720know, having a list of a network of providers, you know, that721you can reference somehow. I do not think that that is going to722happen overnight. We are still arguing with the VA whether this723is an insurance policy or not. What are your suggestions? What724do you think VA could do to encourage more providers into this725program?726    Mrs. Benson. Thank you for the question and thank you for727having me here again.728    I think one of the first things that we need is provider729education. Providers do not know they have to enroll in the730Electronic Funds Transfer (EFT) system. Providers do not know731that it runs on a Medicare-Medicaid background or backbone732versus a TRICARE backbone. I have had to actually walk urgent733carers through how to file and what system to file it on. That734knowledge is going to be key in getting to providers to come on735board.736    What will also be key is providers knowing how much they737are going to get paid. It is fine that there is an acceptable738rate. Most providers I talk to know that it is somewhere within739the Centers for Medicare and Medicaid Services (CMS) rates, but740that it vacillates. For me, and I am a layperson, but looking741back at it going, it is out of IVC, there is a Community Care742Network (CCN), there are already contracts available, it is743mindboggling to me that we cannot use a backbone that is744already there.745    Ms. Brownley. Thank you. My time is up. I yield back.746    Ms. Miller-Meeks. Thank you, Ranking Member Brownley.747    I now recognize Representative King-Hinds for 5 minutes for748any questions she may have.749    Ms. King-Hinds. Thank you, Chairwoman and Ranking Member750Brownley. Before I begin, I want to say thank you to Secretary751Collins and the VA team for making good on the promise to cut752down the significant backlog of veteran claims. That progress753matters not just in numbers, but in real lives, in real754families, and in the trust veterans place in in the755organization. It shows what is possible when the VA focuses on756outcomes instead of obstacles.757    I am also very encouraged that you are finally moving to758modernize CHAMPVA through the Provider Directory for families,759especially in the territories. I am from the Commonwealth of760the Northern Mariana Islands (CNMI). That is the district that761I represent. Simply knowing which providers are available,762which ones accept CHAMPVA, and where they can turn to for care763is very critical. It is long overdue and it is a positive step764and I want to give a big ups and kudos to all of you.765    Even with these improvements, the challenges remains very766serious for my district. The U.S. Government Accountability767Office (GAO) has been very clear. Veterans and their families768in the CNMI and across the territories face some of the highest769barriers to healthcare access anywhere in the United States.770Those same structural gaps, too few providers, limited771specialty care, long distance travel, and virtually no772territory-specific data directly affects the families who rely773on CHAMPVA.774    For us, right, on paper CHAMPVA is available everywhere775where the flag flies. In places like the CNMI or Guam, access776can still feel more theoretical than real. I do not think that777we can fix this issue if we cannot--if we do not know what to778measure. Congress cannot hold the VA accountable without the779data.780    Today I hope that we can have a conversation about the gaps781in data, right, so that these benefits on statute actually782truly works for everyone, no matter which ZIP Code you live at.783    My question then is how can the VA assure Congress that784this program is functioning equitably if it does not track785utilization, access wait times, or outcomes for territories? I786looked, I scoured the Internet, I scoured the GAO reports,787Inspector General (IG) reports, and I do not see any data with788regards to this type of program for the territories.789    Dr. Llorente. Yes, thank you very much for that question.790You are right, to the best of my knowledge, we are not tracking791wait times, we are not tracking specific outcomes for the792beneficiaries that are in the program. We are able to look793based on claims, how many claims are coming from what area. We794have, I do not know the specific data, and we are happy to take795it for the record to find out, you know, by territory, the796number of at least claims that have been paid. That gives us a797sense of the services that are being offered in that area.798    I think that that is one of the reasons why we have come to799appreciate that a Provider Directory is a very first step, but800is a first step, so that we can begin to even assess the801adequacy of the existing providers that we have. It will also802help us to provide more targeted outreach so that if, for803example, to Mrs. Benson's point, we see that there is an area804that lacks a pediatrician that is a CHAMPVA provider, we will805specifically reach out to all of the pediatricians in that806geographic area and try to work with them, maybe work with a807professional organization, for example, to encourage their808participation in CHAMPVA. It is just an example of what we have809been discussing internally as mechanisms to be able to address810some of these problems.811    Ms. King-Hinds. Thank you. I appreciate that. You know, I812do have some data here with regards to Fiscal Year 2023. What813we are seeing in the CNMI is that we have 45 enrollees. We only814have 15 users at a utilization rate of 33.3 percent, which is a815drastic--there is a significant difference with regards to how816the trends are across the United States in comparison to this817utilization number. I just kind of wanted to get a better818understanding of why you think that is and how we can make some819reforms to be able to get more people to be, one, aware of the820program; two, know which care providers that they can go to so821that they can have access to some of this care and, you know,822have the data to be able to justify whatever infrastructure823that need that is needed to be put into place in the824territories.825    Dr. Llorente. Yes, ma'am. What I would like to be able to826do is first obtain the more recent data from Fiscal Year 2025.827The data that you cited is in keeping with what we have seen.828That is, overall, we have about 67 percent utilization of829CHAMPVA services within our total group of enrollees. I would830like to see if there has been any difference between the 2023831numbers that you cited and the 2025 currently.832    Then, you are right, we need to dig into it and try to have833a better understanding of why there are differences if, in834fact, we find differences.835    Ms. King-Hinds. Thank you. I am out of time. Thank you.836    Ms. Miller-Meeks. Thank you very much.837    The chair now recognizes Representative Cherfilus-McCormick838for 5 minutes for any questions she may have.839    Ms. Cherfilus-McCormick. Thank you, Madame Chair, and thank840you, also, Ranking Member, for holding this important hearing.841    You know, serving our veterans, and especially their842families, is one of our primary responsibilities and promises.843I am happy that we are looking at CHAMPVA, especially since it844serves over 700,000 people in Florida. We are looking around my845district, 60,000. We have had several questions to the families846who are using CHAMPVA.847    While CHAMPVA is not perfect, it provides a lifeline to so848many families, and it must continue to be bolstered and849strengthened to adequately serve those who need it the most.850Over the past few years, I have heard from veterans and their851families about their exposure to environmental toxins while852living near the military installations. Whether it is Red Hill853or Camp Lejeune, we have seen the devastating effects of toxic854exposure on families, like cancer, infertility, and855neurodivergent diseases. This is of concern for military856families, and no military family should be left behind to fend857for themselves.858    Dr. Llorente, has your Department looked at expanding the859scope of CHAMPVA to include military families who have been860exposed to toxins?861    Dr. Llorente. At this point in time, the eligibility862criteria are in statute and we include or deem that a family863member is eligible based on those existing criteria. Within the864Veterans and Family Member Program, we do have certain865outcomes-related additional programs, such as the Spina Bifida866Program. We have the smaller Vietnam Veteran Women's whose867children have certain disabilities. Then we also have the Camp868Lejeune family Member program. Each of those is designed for869very specific situations, very specific toxic exposures. Those870are the programs that we currently have.871    Ms. Cherfilus-McCormick. Do you think there could be other872avenues to provide coverage or do you think that CHAMPVA can873solely handle it?874    Dr. Llorente. Well, because I have described some very,875very specific areas, they only cover those areas. We are more876than happy to work with Congress in order to explore any other877areas that, you know, could be assessed and reviewed in the878future.879    Ms. Cherfilus-McCormick. I guess my question also is,880because we are thinking about how many people are actually881being exposed, are there other departments or other areas that882we should look into in addition to CHAMPVA? I do not know if883you would know that answer.884    Dr. Llorente. I was just about to say I do not think that I885am necessarily prepared to address that question today, but886more than happy to take it for the record and reach out to some887of our other program offices that I think are better suited to888be able to address that question.889    Ms. Cherfilus-McCormick. Thank you. While I am optimistic890about the future of CHAMPVA, I understand that the current891program is not without its issues.892    Mrs. Benson, I was deeply disturbed to hear that you had to893put over $110,000 promissory note and CHAMPVA refused to cover894a medically necessary hospitalization. This is definitely895unacceptable. No person, especially the spouse of a veteran who896has served our country, should ever have to put a down payment897just to see a doctor.898    Dr. Llorente, how typical is this required for people to899put down a down payment?900    Dr. Llorente. Congresswoman, I have to be frank with you, I901have not ever encountered this type of a situation before. I902would like to separately reach out to Mrs. Benson to have a903little more detail about the specific circumstances, not only904to be able to address this specific issue, but to have a sense905of, are there gaps that we are not addressing so that we can906figure out what are the steps that need to be taken so it does907not happen to other people.908    Ms. Cherfilus-McCormick. Is this the first time you are909hearing of this kind of situation?910    Dr. Llorente. It is the first time I am hearing of it, yes,911ma'am.912    Ms. Cherfilus-McCormick. Okay. How would you feel if we had913any kind of agreement or arrangement to actually track these914situations and other outliers just so we can make sure that915this is not happening and that there are other obstacles916actually going forward?917    Dr. Llorente. I would very much appreciate any similar918types of situations or any other kinds of cases like this,919specifically because it is our duty. As we have discussed, it920is our duty not only to take care of the veterans and their921families and caregivers, but to fix problems that need to be922fixed.923    Ms. Cherfilus-McCormick. Thank you so much. I yield back.924    Ms. Miller-Meeks. Thank you.925    The chair now recognizes Dr. Dexter for 5 minutes for any926questions she may have.927    Ms. Dexter. Thank you very much to Chairwoman Miller-Meeks928and to Ranking Member Brownley for again having this very929important hearing. Thank you to our witnesses for coming to930testify today.931    According to data from the Veterans Health Administrator's932Office of Integrated Veteran Care, there are over 10,000933Oregonians enrolled in CHAMPVA . To those Oregonians, we have934made a solemn promise, as we have been discussing, that in935return for the immense sacrifices their family members have936made, we will ensure they get access to healthcare services937they need. However, as Mrs. Benson has shared in her testimony,938we continue to fall short on delivering on that promise.939    When a family member who is owed a care through the VA is940sick, the last thing in the world that they should be doing is941fighting through red tape to be seen. They most certainly942should not be signing promissory notes, agreeing to pay943hundreds of thousands of dollars for care in case the VA944payment falls through.945    As the number of CHAMPVA beneficiaries continue to grow946with the Sergeant First Class Heath Robinson Honoring our947Promise to Address Comprehensive Toxics (PACT) Act948implementation, and if more families are forced to turn to this949coverage because Congress is unable to implement a fix to the950ACA premium tax credit enhancement being taken away, we must be951focused on getting this system to work better for families.952    Dr. Llorente, sorry, in your testimony, I was pleased to953see discussion of the need to address the dearth of information954about where CHAMPVA beneficiaries can seek care. As I955understand it, under the current system, beneficiaries have to956individually contact providers, and we have discussed that. It957is obviously frustrating and it needs updating.958    It strikes me that one solution to the dearth of option959available to CHAMPVA beneficiaries would be to require960community care network providers to accept CHAMPVA payments.961This would also have the benefit of meaning VA would only have962to maintain a single Provider Directory. Can you comment on any963statutory or regulatory hurdles that would need to be overcome964to consider this as an option?965    Dr. Llorente. I appreciate that question. I do not know the966answer to that question. Let me check for a moment with Mr.967Fennell to see if, you know, he has some recognition or968knowledge to be able to address it.969    Ms. Dexter. I think it is an unfair thing to ask on the fly970for you to put testimony before a congressional hearing, so I971will just ask that we do--and we ask for many questions to be972responded to, and often we do not get them. If I can just973assure myself that you will get back to me, that is totally974appropriate.975    Dr. Llorente. Absolutely.976    Ms. Dexter. Thank you.977    Dr. Llorente. Yes.978    Ms. Dexter. As this committee continues to discuss and979conduct necessary oversight of this program, Dr. Llorente, can980you share the date on which the number of backlogged981applications peaked and the number of pending applications on982that date, like the high point when we had the worst backlog?983    Dr. Llorente. Yes, ma'am. It was approximately in May of984this year, 2025.985    Ms. Dexter. Okay, thank you. Can you share the percentage986of applications that were approved versus denied in 2025 as987approved compared to the same period in the prior fiscal year?988    Dr. Llorente. I do not know the percent approved in Fiscal989Year 2024. I do know that in Fiscal Year 2025, approximately 80990percent of the applications are approved.991    Ms. Dexter. Okay, thank you. I have heard that VA, to clear992this backlog, they have set up a separate key for--queue,993sorry, for beneficiaries that have another form of insurance994with an unreported backlog. How many applications are in this995queue awaiting a determination from VA?996    Dr. Llorente. I am going to ask Mr. Fennell to address that997question, if you do not mind.998    Ms. Dexter. No. Please, Mr. Fennell.999    Mr. Fennell. Yes, thank you for the question. Currently, we1000are now processing and have the ability to process OHI with the1001application. That is a process improvement that we have1002included in order to expedite both of the processing of OHI,1003other health insurance, and the CHAMPVA application.1004    Right now we are applying automation to those OHI documents1005that are separate and we are able to automate the processing of1006a grand majority of those. We had a height of around 300,0001007when we initiated the queue that you referenced. I think now we1008are in real time, meaning we were processing those as quickly1009as we are the applications themselves. I want to say we might1010have around 20,000 remaining to process. Again, in applying1011this process and automated solutions, that is real time,1012meaning over the next week those will be processed.1013    Ms. Dexter. If I may, to follow up on that, so 300,0001014almost immediately. I am assuming these automated tools are1015Artificial Intelligence (AI)-generated. Is there a quality1016control making sure that the right determinations are happening1017for CHAMPVA?1018    Mr. Fennell. There are. The quality control measures, are1019the business rules that are up front that we apply. Some of1020that may not necessarily be AI as much as just a business rule1021that follows statutory and regulatory guidelines.1022    Ms. Dexter. Okay, thank you. I am over time. Yield.1023    Ms. Miller-Meeks. Thank you very much.1024    The chair now recognizes Dr. Conaway for 5 minutes for any1025questions he may have.1026    Mr. Conaway. Thank you, Chairwoman Miller-Meeks and Ranking1027Member Brownley, for putting this hearing together so that we1028can conduct a much needed oversight on this very important1029program.1030    As of November 2025, CHAMPVA is providing healthcare1031coverage to more than 1 million beneficiaries. At a time when1032healthcare prices are increasing and the expiration of the1033Affordable Care Act is looming, we must strengthen this1034healthcare program for independents and survivors of veterans.1035    In my State of New Jersey, premiums are projected to1036increase by 174 percent. The average annual premium cost could1037jump almost $2,800 on average. For some, it could mean that1038costs will go up by tens of thousands. This is unacceptable. I1039encourage my colleagues to find a solution to this looming1040cliff that so many Americans are facing, will face with respect1041to their healthcare if a solution is not found to the problem1042of the expiration of the premium tax credits.1043    I am curious to know, Ms. Llorente, do you anticipate that1044the expiration of the ACA tax credits will impact enrollment1045for CHAMPVA?1046    Dr. Llorente. Thank you very much. I appreciate that1047question, and I truly do not know the answer. We still would1048need the veteran sponsor to meet the eligibility criteria. That1049becomes, you know, sort of the first thing that has to occur. I1050simply do not know how many spouses or dependents of veterans1051that are 100 percent service-connected, permanent, and total,1052are currently receiving ACA benefits.1053    Mr. Conaway. Are you conducting any planning in1054anticipation of the some 20 million people who are going to1055lose these tax credits? Are you doing any anticipatory planning1056to prepare for a potential influx of new applications as the1057people can no longer afford their health insurance benefit or1058health insurance under the ACA?1059    Dr. Llorente. Our primary planning, and we do work very1060closely with projections and enrollment and as well as with VHA1061Fiscal, has been looking at the increasing numbers year over1062year of beneficiaries who have been enrolling in CHAMPVA. For1063many years that figure was pretty steady, about 5 to 8 percent1064year-over-year growth. Then PACT Act was enacted. That growth1065went to about 13 to 14 percent. During the past year, we have1066seen almost a 22 to 23 percent increase. That in and of itself1067we are and have been tracking very, very closely.1068    We are engaging in projections so that we assure that we1069have sufficient budget currently and in future years to address1070the healthcare needs based on past expenditures with1071adjustments for those increases. Have we factored in impact1072from ACA specifically? No, sir, at this point we have not.1073    Mr. Conaway. Do you know then how many of your enrollees1074also have insurance under the ACA? Do you have that number?1075    Dr. Llorente. I do not. Let me check with Mr. Fennell. Do1076you know?1077    Mr. Fennell. Thank you, sir, for the question. I do not1078know the answer to that question, but I am apprised of the1079eligibility criteria and I do not see a situation where that1080changes with the ACA tax credit, which is permanently and1081totally disabled.1082    Mr. Conaway. Just reclaim my time because I am running out1083of time.1084    Mr. Fennell. Oh, sorry, sir.1085    Mr. Conaway. I just want to get to this question of the1086lack of providers in particular markets and what is being done1087about that. Now, typically, I mean, as one who ran a practice1088years ago, you know, you sort of have to determine--when you1089determine to bring on an insurance policy, how much does it1090pay? Is it worth my time compared to the other insurances that1091I accept covering, you know, people who can come to the office?1092    Is one problem that the CHAMPVA is not paying enough? Two,1093that it is perhaps too difficult for people to enroll in1094CHAMPVA? Have you looked into that and how are you addressing1095those factors which I am sure are impacting the number of1096physicians who are accepting CHAMPVA patients?1097    Mr. Fennell. Yes sir, thank you, and happy to answer that1098question. We are required by law to pay like or similar to1099TRICARE. That is actually those are the payment methodologies1100that are loaded into our system, our TRICARE methodologies. The1101other aspect to this is we are normally a secondary payer1102benefit. If they have Medicare or they have other health1103insurance, that is going to be billed first and I would imagine1104that would be a primary concern to the treating physician. If1105it does get to a secondary payment, we would pay like or1106similar to TRICARE.1107    Ms. Miller-Meeks. Thank you very much, Dr. Conaway.1108    I now recognize myself for 5 minutes.1109    If I can, I am just going to have a point of clarification.1110Certainly myself and members of my party and members of this1111committee want to make sure that healthcare costs are brought1112down for everyone, not just a select few that may be on1113enhanced premium tax credits. The premium tax credits under the1114ACA are not expiring, only the enhanced premium tax credits are1115expiring. I thought I would put forth that clarification since1116this is entered into the record.1117    Additionally, we do not force providers to accept Medicaid.1118We do not force providers to accept TRICARE. Being a provider1119and a veteran, it seems to me that forcing providers to accept1120CHAMPVA who are in the community, would that be considered1121indentured servitude? I will pose that question to Dr. Llorente1122and you can submit an answer in writing.1123    Thank you for that. Just making those points valid that we1124look at the constitutional nature of what it is that we may1125require of someone to do.1126    Dr. Llorente, what is the industry standard for the amount1127of time to process claims, both paper and electronic? Then how1128does the VA compare, if you have that information?1129    Dr. Llorente. Thank you, Chairwoman. I do not know the1130answer to that question, but happy to take it for the record1131and then provide the comparative numbers.1132    Ms. Miller-Meeks. Then I applaud the efforts at getting1133through the backlog and applying more technology to improving1134backlog and also your efforts in trying to keep family members1135and providers up to date on the status of their claims. To that1136end, is the VA using artificial intelligence or augmented1137intelligence to improve both applications, the claims process1138or status, and updates for that? If so, how and, if not, why?1139    Dr. Llorente. Thank you very much for that question. I am1140going to ask Mr. Fennell to address that because he has way1141more technical savvy than I do.1142    Mr. Fennell. Thank you for the opportunity to answer that1143question. It began, as I answered before, with just with1144business rules and loading those into the system to make1145automated decisions. When it comes to artificial intelligence,1146which brings in an additional capability, we are starting to1147apply some of the those capabilities when it comes to these1148newer modernized platforms that we are moving into for1149processing both claims and eligibility applications.1150    Ms. Miller-Meeks. Mrs. Benson, I think that you have1151answered this question in your testimony, but I just want to1152reiterate it. Would it help to have a Provider Directory for1153families and caregivers? If so, are you supportive of1154Representative Kiggans' legislation?1155    Ms. Benson. Thank you for the question. I am not familiar1156with the legislation, but I can say it would be helpful to have1157both a contracted network and a Provider Directory. Yes. Thank1158you.1159    Ms. Miller-Meeks. Great. Thank you. I yield back.1160    I want to thank all our witnesses for being here. I am1161going to recognize Ms. Brownley for any closing remarks you may1162have. Oh, oh, my apologies. We have another member snuck in.1163    The chair now recognizes Representative Kiggans for 51164minutes for any testimony she may have.1165    Ms. Kiggans. Thank you, Madame Chair, for having me here1166today to discuss the Civilian Health and Medical Program of the1167Department of Veteran Affairs, or CHAMPVA, and to highlight how1168Congress can improve this program for our veteran caregivers1169and dependents.1170    I represent Hampton Roads, Virginia, which is home to1171thousands of veteran families who use the CHAMPVA system to1172support our Nation's veterans and to access their veteran1173healthcare. Caregiving requires tremendous sacrifice, but1174access to quality healthcare should not be one of them.1175    CHAMPVA is a vital program for the caregivers and1176dependents of permanently disabled veterans. It ensures they1177can continue to support the veteran in their lives and still1178receive the healthcare services they require. However, it can1179be difficult for caregivers and dependents to find providers in1180their community that accept CHAMPVA. On most occasions,1181caregivers have to do their own research and find specific1182providers that will take their coverage.1183    To rectify this situation, I introduced the Clarity on Care1184Options Act, which directs the VA's Community Care Network to1185create a public-facing list of all providers who are in network1186for CHAMPVA enrollees. We must make this provider information1187accessible to caregivers and dependents of disabled veterans.1188The easier we make finding healthcare for our caregivers, the1189more time they can spend with their loved ones.1190    I want to thank our witnesses for taking the time to1191educate us about the gaps we see in this program and what we1192can do to help increase support to those who support our men1193and women who served our country. With that, I have another few1194questions for our witnesses if there is time.1195    When it comes to finding providers that accept CHAMPVA, how1196has your experience, and this is for Mrs. Benson, how has your1197experience been? Is there any difficulty locating specialty1198healthcare providers who accept CHAMPVA?1199    Mrs. Benson. Thank you for the question. Yes, there is a1200terrible issue. Back to the hospitalization I mentioned, I had1201a daughter who needed specialty care. I called 26 hospitals1202across the Nation, only 1 would take her. Even today I pay out1203of pocket. No mental healthcare provider, and I am in Florida1204between very two large metropolises, accepts CHAMPVA for teens.1205Even for myself, if it is not hospitalization, which is1206mandated to file, only one major network takes it. We end up1207paying most of our care out of pocket, above and beyond CHAMPVA1208and cash.1209    Ms. Kiggans. Thank you. Mr. Zenner, from your perspective,1210what barriers do you often see beneficiaries of CHAMPVA face1211when it comes to accessing their benefits?1212    Mr. Zenner. Yes, thank you for the question. Very similar:1213lack of education of providers, confusion with the CHAMPVA card1214itself are two of the biggest barriers that we currently see as1215County Veteran Service Officers.1216    Ms. Kiggans. Would a directory or a list of providers of1217sorts be beneficial then?1218    Mr. Zenner. Yes, ma'am.1219    Ms. Kiggans. In these cases for sure.1220    Mr. Zenner. Yes, ma'am.1221    Ms. Kiggans. Then for Dr. Llorente, many caregivers report1222learning about CHAMPVA only years after becoming eligible, in1223most cases, as the program is currently. How do veteran1224dependents find out about CHAMPVA?1225    Dr. Llorente. Yes, thank you very much for that question.1226There are a couple of different ways. One is that part of the1227changes that have occurred in VBA when the veteran becomes1228permanent and total 100 percent, part of the packet that they1229receive describing the rating includes information about1230CHAMPVA for their dependents and how to enroll in the program.1231    A second way is the CHAMPVA program itself does do direct1232outreach to potentially eligible beneficiaries, advising them1233of the program and how to apply for it. We are continuing to1234also engage in additional outreach efforts because one of the1235things that we have discussed internally is that we could1236certainly be doing a better job of putting promoting this1237benefit.1238    Ms. Kiggans. Specifically, how is the VA improving the1239CHAMPVA's phone and customer service operations given reports1240of long wait times and inconsistent information.1241    Dr. Llorente. We have engaged in a series of steps toward1242that. One is we have increased contractor support that can be1243specifically surged during peak times.1244    In addition to that, we are working on implementing some1245new telephony systems so that it will begin to offer more in1246the way of self-service, so that those issues that can be1247addressed via self-service are addressed. Then it moves those1248clients, those persons that need agent-assisted calls, it sort1249of, you know, separates out the ones that can be handled via1250self-service.1251    In addition to that, we are looking at our workflows,1252streamlining some of those, being able to standardize some of1253the workflows as well, because there are things that we have1254identified that are being done, you know, with too much1255variance, and that is also then leading to some of the delays.1256Just a few examples.1257    Ms. Kiggans. Yes. Great. Thank you for working on that.1258Last question, as the VA can--no, I am sorry. Maybe I will save1259it for later.1260    Thank you. I yield back.1261    Ms. Miller-Meeks. Just to know that I am fair to everyone1262in the hearing room. Thank you. Your time has expired. The1263gentlewoman yields back.1264    I now recognize Ranking Member Brownley for any closing1265statements you may have.1266    Ms. Brownley. Well, I would just say, Madame Chair, I thank1267you for having this hearing. I think it is--we need to get the1268VA back to briefing staff so we can keep updating on, you know,1269what progress is being made. That is the frustration. We do not1270have a plan in front of us. We do not have a timeline in front1271of us. There is no way for us to do the oversight that we1272really need to do.1273    This is an important program that we need to get right. I1274think we are all clear on where the problems lie and what needs1275to be done. It is just--it is a matter of doing it. If the1276Secretary was willing to hire more people or give people more1277overtime to deal with the backlog, we need to do the same to1278all these other problematic areas to get them, you know, up to1279speed and running.1280    I honestly believe that if we accept the fact that CHAMPVA1281is more like an insurance plan than a medical care benefit, you1282will see directly what needs to be done and how to do it if you1283just follow the model of what insurance plans do, including a1284directory of providers, whatever. You know, we need to have the1285oversight. I hope we can have another hearing to do our due1286diligence as we move forward.1287    I thank you all for being here. Mrs. Benson, thank you for1288being here. Thank you for all the help that you do for so many1289other veterans who need your help, veterans, their families,1290and caregivers who need your help and support.1291    I yield.1292    Ms. Miller-Meeks. Well, certainly it is an important1293hearing. I appreciate, Dr. Llorente, what you and the office1294has done to improve the backlog. Then your continued work on1295keeping family members and caregivers, trying to improve the1296knowledge of where their claims are. Then the other efforts1297that we need to take on provider education, as Mrs. Benson and1298Mr. Zenner had said, how to file claims and how much they are1299paid so that we can get providers into this very important1300program to make sure that both family members, spouses, and1301caregivers are aware and have access to the benefits that those1302veterans have earned for them.1303    I would like to take this time to thank everyone for their1304participation. Thank you so much for your patience and I do1305apologize. Although it was out of my hands, I still feel it is1306necessary to apologize for the inconvenience to you all and to1307those who wanted to participate in today's hearing. I1308appreciate the discussions we have had on this important topic1309and we will continue to have oversight.1310    The complete written statement of today's witnesses will be1311entered into the hearing record.1312    I ask unanimous consent that all members have 5 legislative1313days to revise and extend their remarks and include extraneous1314material. Hearing no objections, so ordered.1315    I thank the members and the witnesses for their attendance1316and participation today. This hearing is now adjourned.1317    [Whereupon, at 4:44 p.m., the subcommittee was adjourned.]1318=======================================================================13191320                         A  P  P  E  N  D  I  X13211322=======================================================================13231324                    Prepared Statements of Witnesses13251326                              ----------13271328                  Prepared Statement of Maria Llorente13291330    Chairwoman Miller-Meeks, Ranking Member Brownley, and distinguished1331Members of the Subcommittee. Thank you for the opportunity to testify1332today about the Civilian Health and Medical Program of the Department1333of Veterans Affairs (CHAMPVA), a vital program that provides health1334care coverage to eligible spouses, children, survivors, and caregivers1335of qualifying Veterans.1336    Joining me today is Mr. David Fennell. He is the Director of1337Veteran and Family Member Programs in the Office of Integrated Veteran1338Care.1339    CHAMPVA plays a critical role in supporting the families of1340Veterans who have made profound sacrifices in service to our Nation. My1341testimony today will provide an overview of the program's eligibility1342criteria, current operations, recent improvements, and opportunities1343for continued collaboration with Congress to ensure timely, efficient,1344equitable access to care.1345    Authorized under the United States Code, Title 38 Section 1781,1346CHAMPVA provides health care coverage to eligible spouses, surviving1347spouses, and children of Veterans who are permanently and totally1348disabled due to a service-connected disability, who died as a result of1349a service-connected condition(s), or who died while rated permanently1350and totally disabled from a service-connected condition(s). It also1351covers certain survivors of persons who died in the line of duty and1352certain Primary Family Caregivers under the Program of Comprehensive1353Assistance for Family Caregivers. To be eligible for CHAMPVA, the1354individual cannot be eligible for TRICARE.1355    As of November 2025, CHAMPVA provides health care coverage to more1356than one million beneficiaries. The program receives approximately13574,000 new applications per week. More than 90 percent of medical and1358pharmacy claims are processed electronically within days of receipt,1359ensuring timely reimbursement and continuity of care.1360    Under the leadership of Secretary Douglas A. Collins and thanks to1361recent reforms, the application backlog--previously exceeding 70,0001362cases--has been eliminated. New applications are now processed in a1363matter of days. The appeals backlog has also been reduced from over136420,000 to approximately 1,000, with continued progress underway. These1365improvements reflect the Department of Veterans Affairs' (VA)1366commitment to Veteran-first service delivery, accountability, and1367efficiency.1368    Under the last Administration, CHAMPVA faced significant delays in1369application and appeals processing due to increased demand, staffing1370constraints, and reliance on legacy manual systems. Some applicants1371waited over 150 days for determinations. Under Secretary Collins'1372leadership, VA implemented a two-pronged strategy: authorizing overtime1373for application processors and introducing enhanced process engineering1374and new automation to streamline workflows. These actions have assured1375timely access to benefits for eligible CHAMPVA beneficiaries.1376    VA is modernizing CHAMPVA operations to reduce bureaucracy and1377improve the user experience. In December 2025, we will complete the1378transition to a more automated application processing system,1379increasing efficiency and reducing manual workload. These efforts align1380with VA's broader digital transformation strategy and support the1381Department's goals of transparency, reduced administrative burden, and1382improved outcomes for Veterans' and VA beneficiaries.1383    Access to accurate provider information is another area of focus.1384Although CHAMPVA beneficiaries may see any provider who accepts1385CHAMPVA's allowable rates, VA acknowledges that beneficiaries may1386experience difficulty identifying participating providers or confirming1387whether a provider is accepting new patients. We are working to improve1388how provider information is presented and maintained, including1389updating publicly available guidance and strengthening communication1390with providers who bill CHAMPVA.1391    We appreciate the continued interest in strengthening CHAMPVA. Over1392the last few months, VA has made significant strides in eliminating1393backlogs, modernizing systems, and improving access. We remain focused1394on delivering timely, high-quality service to those who have sacrificed1395so much.13961397Conclusion13981399    This concludes my statement. We look forward to responding to any1400questions that you may have.14011402                   Prepared Statement of Caira Benson14031404    Chairman Miller-Meeks, Ranking Member Brownley, and Members of the1405House Veterans' Affairs Subcommittee on Health, thank you for inviting1406me to testify today. It is my honor to return to further the discussion1407on the inefficiencies and inequalities within the Department of1408Veterans Affairs' (VA) Civilian Health and Medical Program of the1409Department of Veterans Affairs (CHAMPVA).1410    At the Code of Support Foundation (COSF), we work with veterans and1411their families every day. Our digital resource hub, PATRIOTlink, has1412served over 67,000 military community members to find needed supports1413for active duty servicemembers, veterans, caregivers, family members,1414and survivors. Every day our case management team works to connect1415active duty servicemembers, veterans, caregivers, family members, and1416survivors to local, regional, national, and government partners to1417achieve needed financial, social, physical health, and mental health1418supports to achieve stability. At COSF, we are in the records daily and1419in-tune with the needs of the military community.1420    But I am not just here as an employee of a veterans' non-profit. I1421am here as a caregiver, advocate, and a CHAMPVA user. I care for my1422husband who deployed twice to Iraq as a combat engineer between 2003-14232006. My husband suffered multiple Traumatic Brain Injuries (TBIs)1424during his years in service; however, it would take until 2018 to1425formally diagnose those TBIs, despite a clear record of evidence. It1426would take another year to figure out his case was complicated by toxic1427encephalopathic process, most likely due to chemical exposures. Today,1428Eric is unable to work, needs full-time care, and is seen by a1429university neurological team due to the complexity of his case.1430    My five children and I enrolled in CHAMPVA in 2017 when my husband1431was awarded Permanent and Total status for his service-connected1432injuries. We breathed a sigh of relief knowing that we would have the1433safety net of health insurance for myself and our children, three of1434whom have needed specialty medical care through the years.1435    I testified in June of this year to this subcommittee about the1436nightmare navigating CHAMPVA has been for our family. Highlights of1437that nightmare include having to sign a $110,000 promissory note to1438ensure a needed hospitalization occurred in the chance that CHAMPVA1439refused payment, putting needed medical care on hold while waiting 61440months for preauthorization, being sent to collections when CHAMPVA1441claim payments didn't occur in a timely manner with one provider1442waiting over 27 months to receive payment for services. CHAMPVA's1443``appropriate care'' has felt anything but appropriate. Indeed, I still1444find our family's health needs are in arrears because we hesitate to1445use the complicated system which many in my area will not file.1446    I will not rehash my testimony given in June of this year - I know1447the committee is interested in how the situation looks for CHAMPVA1448users today, if the changes have been made, and how those changes have1449been received since my last testimony.1450    I commend VA for finally clearing the CHAMPVA application backlog.1451It is beyond time to process applications in real time. I also was1452overjoyed to hear that claims being submitted electronically are being1453paid quicker than previously.1454    Yet, even with that good news, the situation on the ground for1455CHAMPVA users remains murky. While the application backlog is cleared,1456only two families I knew waiting on their decisions have received1457notifications of such to date.1458    Provider acceptance of CHAMPVA still remains a challenge. As a user1459myself, I had a medical complication this year which required me to1460travel over an hour for out-patient procedures as they were the nearest1461provider willing to file.1462    Even living in last year's fastest-growing county in the Nation, I1463still cannot find a pediatrician who will file CHAMPVA for primary1464pediatric care for my children. I still pay out-of-pocket for my1465children's mental health providers as we have yet to find a provider1466who accepts CHAMPVA.1467    I know I am not alone. At COSF, one of our most frequent requests1468is mental health supports for dependents. We have multiple national and1469regional providers we work with to provide such supports for our1470clients. Five of these take TRICARE and refuse to take CHAMPVA. To1471quote one, ``VA is too difficult to work with.''1472    I feel those words deeply. Indeed, the difficulty of the process1473has made me personally stop filing for reimbursement. It is one more1474bureaucratic fight that caregivers like me do not need.1475    It is hard to place blame on providers for declining to accept and1476file CHAMPVA. Indeed, VA has made it difficult on providers filing1477claims and on users looking for providers. There is no known provider1478network or contracts outside of CHAMPVA's pharmacy component run by1479OptumRX.1480    I have talked to multiple providers who tell me there is no1481published fee schedule. While there is a ``CHAMPVA acceptable pay1482rate,'' most providers do not know what that is until they are paid or1483until the patient receives their Explanation of Benefits (EOB). Most1484providers tell me they understand the acceptable rate is based on1485Centers for Medicaid & Medicare Services (CMS) rates, however pay can1486vacillate lower than the Medicare rate. By agreeing to file the claim,1487providers are barred from recouping any difference between the expected1488and paid rates.1489    Claims filing is messy, at best, with many providers still filing1490via paper claims through either the local VA Medical Center (VAMC) or1491CHAMPVA mail-in centers, depending on what current local advice is.1492Several providers I spoke to were unaware of the ability to file claims1493electronically.1494    Claim payment times are not guaranteed. Some claims are paid in1495weeks; some claims are paid in years. Payments for claims are delayed1496by filing codes that are, unbeknownst to the filer, not accepted by1497CHAMPVA causing denials, and requiring refiling. Delayed payment means1498that I routinely talk to CHAMPVA users who have their accounts sent to1499collections by providers due to the length of time between claim filing1500and claim payment. Indeed, I had two such discussions just last week.1501    I recently learned that VA now offers an app where family members1502can look up CPT codes to ensure services are covered. And I ask this -1503why am I, as a caregiver and dependent, required to do what every other1504insurance agency does through yearly contract updates to their provider1505network?1506    As they did in the Senate Veterans' Affairs Committee on May 21,15072025, VA has argued in the past that CHAMPVA is not an insurance1508product, it is a medical service. I remain steadfast--the industry, the1509Federal Government, and, more often than not, the VA treats CHAMPVA as1510an insurance product. For instance, like those covered by Medicaid,1511Medicare, or TRICARE, CHAMPVA enrollees may not take part in the drug1512cost reduction programs offered to patients on fixed or low incomes. If1513we choose to shop for insurance through the Health Care Marketplace,1514CHAMPVA enrollees are not eligible for either financial assistance nor1515advance premium tax credits. Every year, CHAMPVA enrollees receive a15161095-B attesting to the fact that CHAMPVA counts as minimum essential1517coverage under the Affordable Care Act. Finally, even VA states that1518CHAMPVA is only available to caregivers enrolled in VA's Program for1519Comprehensive Assistance for Family Caregivers (PCAFC) when they have1520no other health insurance. Thus, CHAMPVA identifies itself as an1521insurance plan when it offers proof of coverage and bars use of its1522plans in the face of other coverage.1523    CHAMPVA provides EOBs, approves and denies diagnostic codes,1524approves and denies medical treatment codes, and remits payment for1525enrollees to providers for approved services rendered by the medical1526community. CHAMPVA even has out-of-pocket maximums, deductibles,1527copays, and a medication formulary with tiered pricing. With the1528exception of the difficulty of use, CHAMPVA feels like every other1529insurance product I have ever received through an employer.1530    Indeed, the stance that CHAMPVA is not an insurance product is1531detrimental to veterans' families. At COSF, I recently walked a1532Permanent and Totally disabled veteran through enrollment for his wife1533into CHAMPVA. Prior to reaching out to us, this veteran had purchased1534insurance for his dependent through the Healthcare Marketplace, not1535understanding that CHAMPVA provided Patient Protection and Affordable1536Care Act, or ACA, complaint coverage.1537    I am positive we will hear today from VA that CHAMPVA is equivalent1538to TRICARE. Except, we users know it is not. TRICARE has contracted1539rates and a published fee schedule. TRICARE has mandated electronic1540filing and a clear appeals system. Treatments we know are covered under1541TRICARE are not always covered under CHAMPVA. Some other major1542differences:15431544      TRICARE offers TRICARE Young Adult allowing for coverage1545for dependents 18-21 (23 if in college). CHAMPVA coverage ends on the1546dependents 18th birthday unless enrolled in school.15471548      TRICARE offers coverage for stepchildren until the1549marriage ends in divorce. CHAMPVA's stepchild coverage ends at 18 or1550when the child leaves the domicile, meaning a stepchild who changes1551their address to go to college could be dropped.15521553      TRICARE retirees may choose Federal Employees Dental and1554Vision Insurance Program (FEDVIP) which provides orthodontia coverage1555for dependents. CHAMPVA enrollees may only choose VA Dental Insurance1556Program (VADIP), where orthodontia was cut from the leading plan this1557year (DeltaDental).15581559    Appeals for denied coverage under CHAMPVA are difficult to navigate1560as well. I recently had a caregiver call me because her child's recent1561claim for an ambulance ride during an anaphylaxis event was denied by1562CHAMPVA. It took over an hour of digging claims denial letters, EOBs,1563and CPT codes to understand what had happened - the denial was due to1564an inaccurate billing code which was billed under both an individual1565code and a packaged CMS code. CHAMPVA had paid the packaged code but1566denied the individual code, and we do not believe the CHAMPVA enrollee1567will be charged for the ambulance ride.1568    The denial letters listed three appellate structures: a1569supplemental claim or higher-level review through the Veteran Family1570Member Program (VFMP) appeals office or an appeal to the Board of1571Veterans' Appeals. Yet, the CHAMPVA website states there is a clinical1572appeal option that was not mentioned in the denial letter. How does a1573CHAMPVA user without extensive knowledge understand the next steps to1574appeal a denied claim? What was also glaringly missing? Something1575considered routine in today's world of denied insurance claims - an1576option for a third-party review for denied services.1577    In short, CHAMPVA remains a complicated mess for users. The1578historically large gap between enrollees and users validates this1579difficulty. In the 2024 congressional report, Health Care for1580Dependents and Survivors of Veterans (RS22483), the gap is evidenced1581across the decades with 2024 having over 700,000 enrollees but only1582488,000 users.1583    While VA has announced positive steps to easing some of the known1584CHAMPVA problems, CHAMPVA fixes are far from complete.1585    CHAMPVA users need:15861587      Statutory change to bring parity to stepchildren;15881589      Statutory clarity to allow for a contracted provider1590network with clear, contracted CPT codes and published fees, similar to1591the modernization of CHAMPUS to TRICARE;15921593      Regulatory updates establishing a provider network with1594clear, contracted CPT codes and published fees;15951596      Mandated electronic claims filing; and15971598      Clarity in claims appeals processes, including a third-1599party review.16001601    We also need you as a subcommittee to remember who receives CHAMPVA1602eligibility - TRICARE ineligible dependents of permanently and totally1603disabled veterans, survivors of those same veterans, and those enrolled1604in PCAFC with no other health insurance. In other words, our most1605vulnerable community members.1606    In VA's mission, ``To fulfill President Lincoln's promise to care1607for those who have served in our Nation's military and for their1608families, caregivers, and survivors,'' CHAMPVA is failing. As a1609community, we cannot continue to allow this egregious lapse of coverage1610for those who need it most.1611    We at COSF stand ready to work alongside VA and this Committee to1612help modernize CHAMPVA. I thank you for your time and attention, and I1613look forward to your questions.16141615                   Prepared Statement of James Zenner16161617    Chairman Bost, Ranking Member Takano, and distinguished members of1618the Committee, on behalf of the National Association of County Veteran1619Service Officers (NACVSO), we thank you for the opportunity to provide1620written testimony for the record. We value this Committee's steadfast1621commitment to improving the benefits, services, and systems that1622directly impact veterans and their families across the Nation.1623    To begin, NACVSO would like to extend sincere appreciation to the1624staff at the CHAMPVA offices for their extraordinary work in reducing1625the application backlog. We are hearing consistent reports from our1626members that CHAMPVA applications are now averaging close to 10 days1627for initial processing, with some cases moving in as few as four. This1628progress is not merely administrative--it is lifesaving. It means1629eligible dependents gain timely access to health care coverage without1630enduring prolonged periods of uncertainty. These teams deserve real1631credit for this achievement.1632    Our testimony today is offered with respect for our partners at1633CHAMPVA and with a shared goal: to identify practical refinements that1634would increase accessibility, transparency, and efficiency for eligible1635family members and for the Government Veteran Service Officers (GVSOs)1636who serve them.16371638        1. Modernizing CHAMPVA Applications by Enabling Digital1639        Submission16401641    As previously mentioned, NACVSO represents government-employed1642veteran service officers across the country. As accredited1643representatives, these officers act as the primary navigators for1644veterans and their families who rely on them to access the benefits1645they have earned. Yet, when assisting dependents with CHAMPVA1646applications, these advocates face a significant barrier: there is1647currently no mechanism for GVSOs to submit CHAMPVA applications1648electronically.1649    To help a dependent apply, a GVSO must print out the application,1650complete it by hand with the applicant, and then fax or mail it to the1651CHAMPVA office. This process prevents accredited representatives from:16521653      receiving a digital confirmation of submission,16541655      tracking the application's progress, and16561657      providing timely updates when a dependent calls for1658assistance.16591660    Meanwhile, veterans eligible for VA.gov have access to online1661submission portals--but many dependents do not, as they lack a VA.gov1662profile and therefore cannot fully engage in self-service options.1663    CHAMPVA applications are ready for modernization. NACVSO recommends1664the development of a digital submission workflow, modeled after the1665Veterans Benefits Administration's successful National Work Queue1666rollout. A similar system for CHAMPVA would:16671668      generate submission confirmations for applicants and1669accredited reps,16701671      show real-time status updates (e.g., ``received,'' ``in1672review,'' ``decision made''),16731674      reduce administrative burden on CHAMPVA staff, and16751676      increase trust and transparency for families.16771678    A viable path forward may include enabling eligible survivors and1679dependents to obtain VA.gov access specifically for benefits and1680CHAMPVA-related documentation.1681    In parallel, expanding VA Form 21-22 authority--which formalizes1682representation between claimants and accredited organizations--to1683include the Veterans Health Administration and its subordinate entities1684(including CHAMPVA offices) would allow NACVSO's accredited officers to1685communicate directly with CHAMPVA staff. This would reduce delays,1686minimize errors, and empower GVSOs to resolve issues on behalf of1687families more efficiently.16881689        2. Increasing Provider Awareness and Participation16901691    A persistent challenge reported nationwide is the lack of1692understanding among community healthcare providers about what CHAMPVA1693is, who it covers, and how reimbursement works. Many providers have1694never encountered CHAMPVA before; some conflate it with TRICARE or with1695VA Community Care. This lack of knowledge discourages provider1696participation and creates avoidable access-to-care barriers for spouses1697and dependents.1698    NACVSO recommendations to expand provider awareness include:16991700      Targeted campaigns to large provider networks, hospital1701systems, and independent practices explaining CHAMPVA coverage and1702billing processes.17031704      Provider-focused training materials, such as webinars or1705downloadable toolkits, distributed through VA's Office of Community1706Care and regional CHAMPVA liaisons.17071708      Inclusion in electronic health record (EHR) billing1709libraries, ensuring CHAMPVA appears as an easily selectable insurer.17101711      Partnerships with professional associations to1712disseminate CHAMPVA guidance, if not already active.17131714    These efforts would immediately expand access for eligible1715dependents by reducing confusion at the point of service.17161717        3. Redesigning CHAMPVA Identification Cards17181719    Community providers frequently confuse the CHAMPVA identification1720card with the VA Community Care card, resulting in some instances where1721a dependent is turned away for care. This confusion burdens families1722and forces repeated follow-up with CHAMPVA and GVSOs.1723    NACVSO recommends that VA explore restyling CHAMPVA eligibility1724cards to create a distinct, easily recognizable format. Clear1725differentiation--both visually and textually--would minimize confusion1726and support smoother interactions with community providers nationwide.17271728        4. Addressing the CHAMPVA Coverage Gap for Dependent Students17291730    A particular issue arises during the transition period when a1731dependent turns 18. Under current policy, CHAMPVA eligibility lapses1732unless the dependent is enrolled full-time in school and provides1733verification to CHAMPVA. Unfortunately, the processing time for this1734school enrollment certification often stretches eight to 9 months,1735creating a substantial coverage gap.1736    During this period:17371738      dependents incur medical expenses out of pocket,17391740      families must attempt reimbursement long after the care1741has occurred,17421743      claims may be forgotten or lost, and17441745      dependents undergo administrative burdens during what1746ought be a routine eligibility continuation.17471748    This gap is perplexing given that VBA has already determined1749eligibility for the underlying veteran benefit that establishes1750Dependent's Education Assistance and CHAMPVA access. NACVSO recommends1751a few potential mitigation strategies such as:17521753      Provisional Continuation of Coverage:17541755          Allow dependents to maintain uninterrupted CHAMPVA1756        coverage for a defined period (e.g., 6 months).17571758      Direct Data Exchange with Educational Institutions:17591760          Establish an automated system where schools can1761        provide enrollment verification directly to CHAMPVA, similar1762        existing VA education certification offices.17631764      Online Certification at VA.gov for Dependent Students:17651766          Similar to existing VA.gov profiles, access would1767        allow dependents to upload proof of enrollment through an1768        online portal that generates a timestamp and receipt.17691770      Pre-verification reminders:17711772          Create automated notices 6 months before the1773        dependent's 18th birthday.17741775    Addressing this single chokepoint would eliminate a1776disproportionate amount of confusion and financial strain for thousands1777of families each year.1778    Overall CHAMPVA is performing well, and the reduction in1779application backlog stands as clear evidence of the dedication of VA's1780workforce. But as with any successful program, continued refinement is1781both necessary and possible.1782    Government Veteran Service Officers are uniquely positioned to1783assist VA in improving the CHAMPVA experience for eligible family1784members. As the front-line, accredited advocates charged with helping1785veterans and their dependents navigate Federal benefits, GVSOs see1786these challenges--and potential solutions--every day. NACVSO stands1787ready to support VA and this Committee in modernizing processes,1788expanding access, and ensuring that the families of our veterans1789receive the timely, reliable health coverage.1790    Thank you for your continued leadership and for the opportunity to1791provide testimony. NACVSO remains committed to working with the1792Department of Veterans Affairs, CHAMPVA leadership, and Congress to1793strengthen all programs for those who served and those who stand1794alongside them.17951796Jim Zenner,17971798Policy Director, NACVSO17991800Director of Military and Veteran Affairs of Los Angeles County18011802                       Statements for the Record18031804                              ----------18051806     Questions for the Record Submitted by Marianette Miller-Meeks1807[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]18081809     Response to Questions for the Record Submitted by Caira Benson1810[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]18111812 Response to Questions for the Record Submitted by U.S. Department of1813                            Veterans Affairs1814[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]18151816Response to Questions for the Record Submitted by National Association1817                  of County Veterans Service Officers1818[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]18191820          Prepared Statement of Paralyzed Veterans of America18211822    Chairwoman Miller-Meeks, Ranking Member Brownley, and members of1823the subcommittee, Paralyzed Veterans of America (PVA) appreciates this1824opportunity to share our views on how to strengthen the Civilian Health1825and Medical Program of the Department of Veterans Affairs (CHAMPVA) for1826survivors and dependents.1827    CHAMPVA is a comprehensive healthcare program for the spouse or1828widow(er) and children of an eligible veteran. The Department of1829Veterans Affairs (VA) shares the cost of certain healthcare services1830and supplies provided through this program with eligible beneficiaries.1831It may also provide benefits to the Primary Family Caregiver through1832the Program of Comprehensive Assistance for Family Caregivers.1833    Accessing healthcare through CHAMPVA can be challenging for several1834reasons. Until recently, just getting an initial application for1835CHAMPVA health coverage approved took months. In late November, VA1836announced it eliminated a backlog of more than 70,000 CHAMPVA1837applications. They are processing new applications in a handful of1838days, and the department says they can process more than the 4,000 new1839applications per week that it currently receives.1840    They substantially reduced the number of pending appeals as well,1841from roughly 20,000 earlier this year to about 1,000 today. Their1842success in reducing the backlog for both claims and appeals is properly1843attributed to Secretary Collins' decision to use overtime pay for VA1844staff to get the job done, while streamlining the process and1845leveraging automation to speed it up. VA expects to move to a more1846automated application processing system this month, which will increase1847the efficiency of processing CHAMPVA applications. It will also ensure1848that most medical services and pharmacy claims are electronically1849processed within days of receipt for more timely payment.1850    There may be some lingering concerns regarding payment holds for1851CHAMPVA providers. These holds are placed on providers who have not1852enrolled in electronic funds transfer, and we understand there are1853thousands of them in this position. The lack of timely reimbursements1854has plagued the program, and we urge the department to work with these1855providers to resolve the problem as quickly as possible.1856    Finding providers that accept CHAMPVA has always been a vexing1857issue for several reasons. The paperwork burden for the program is1858high, insurance denials can be troublesome, there is no network to1859manage rates or fee schedules, and reimbursement rates are extremely1860low, making those provided by other Federal and private plans far more1861attractive. We encourage Congress to work with VA to address each of1862these problem areas.1863    Coverage for a veteran's children under CHAMPVA currently expires1864when they turn 18, unless they are full-time students. In this case,1865they continue to receive coverage until they turn 23, stop attending1866school full-time, or get married. However, for most Americans with1867health insurance, their adult children can remain on their plan until1868age 26 with no separate premium, as mandated in the Patient Protection1869and Affordable Care Act (ACA) (P.L. 111-148). CHAMPVA and the1870military's TRICARE programs were not affected by the ACA, so they1871required separate congressional action to extend these benefits to1872children up to age 26. This discrepancy was addressed for TRICARE in18732011 and H.R. 1404, the CHAMPVA Children's Care Protection Act would1874fix this for VA's CHAMPVA program.1875    The delay in making this change to CHAMPVA has adversely impacted1876several of our members, including PVA member Amy and her husband. She1877served honorably in the U.S. Marine Corps before an SCI/D cut her1878military service short. Her husband served in the Marine Corps as well,1879but injuries he sustained in Operation Desert Storm curtailed his1880military career, too. Both have 100 percent disability ratings from the1881VA. Their two boys have severe immune deficiencies that were caused by1882their parents' exposure to hazards during their military service. As a1883result, the boys require weekly plasma infusions to keep them alive.1884These infusions cost thousands per month, and they cannot afford to pay1885for them out of pocket. They rely on CHAMPVA to provide this life-1886saving care and suffered tremendous angst when their oldest child1887turned 18. Fortunately, he became well enough with the infusions that1888they were able to keep him in school and CHAMPVA until he turns 23 in1889March 2026. The younger child is currently 17 but he has additional1890comorbidities that may not allow him to do the same. The family is1891straining under the pressure that the lack of action from Congress has1892put on them, and unless legislation like this is passed, there is a1893very real possibility that both children will age out of the program1894next year.1895    The VA testified in opposition to the companion measure to this1896bill during a May 1, 2025, Senate Veterans' Affairs Committee hearing.1897The witness correctly stated that CHAMPVA was not affected by the ACA,1898but we disagree with VA's assertion that it is not health insurance1899because it clearly functions like it. For example, certain types of1900care and services require preauthorization. This approval is extremely1901important, and the failure to obtain it may result in denial of the1902claim. Also, providers must be properly licensed in their State to1903receive payment from CHAMPVA, and they cannot be on the Medicare1904exclusion list. To be reimbursed, providers must file a claim, using1905diagnosis and procedure codes that all other healthcare plans follow.1906    The congressional Research Service (CRS) which advises Congress on1907programs like this seems to agree. In its October report to Congress on1908VA healthcare programs for dependents and survivors, CRS stated,1909``CHAMPVA is primarily a health insurance program where certain1910eligible dependents and survivors of veterans receive care from private1911sector healthcare providers. The program is administered by the1912Veterans Health Administration (VHA), Assistant Under Secretary for1913Health (AUSH) for Integrated Veteran Care, Office of Integrated Veteran1914Care (IVC). The law (38 U.S.C. Sec. of veterans, 1781) requires CHAMPVA1915to provide for medical care in the same or similar manner and subject1916to the same or similar limitations as medical care is furnished to1917certain dependents and survivors of active duty and retired members of1918the Armed Forces under [the Department of Defense (DOD) TRICARE1919program].'' \1\1920---------------------------------------------------------------------------1921    \1\ Health Care for Dependents and Survivors of Veterans, October192216, 2024.1923---------------------------------------------------------------------------1924    DOD's TRICARE program wasn't affected by the ACA either, but1925Congress created the TRICARE Young Adult program in 2011, which1926provides health care for qualified young adults aged 21 to 26 who are1927unmarried and not eligible for an employer-sponsored health plan. Our1928government should not deem veterans' dependents and survivors less1929worthy than civilians for support. Those who are eligible for CHAMPVA1930should be able to retain their healthcare coverage until their 26th1931birthday just like those in private and Federal healthcare plans. H.R.19321404, the CHAMPVA Children's Care Protection Act, would raise CHAMPVA's1933eligibility age to 26, making it consistent with all other Federal and1934private plans. We urge Congress to pass this legislation as quickly as1935possible.1936    PVA would once again like to thank the subcommittee for the1937opportunity to submit our views on CHAMPVA. We look forward to working1938with you on this important issue and would be happy to take any1939questions for the record.19401941  Information Required by Rule XI 2(g) of the House of Representatives19421943Pursuant to Rule XI 2(g) of the House of Representatives, the following1944information is provided regarding Federal grants and contracts.19451946                            Fiscal Year 202619471948Department of Veterans Affairs, Office of National Veterans Sports1949Programs & Special Events--Grant to support rehabilitation sports1950activities--$368,500.19511952                            Fiscal Year 202519531954Department of Veterans Affairs, Office of National Veterans Sports1955Programs & Special Events----Grant to support rehabilitation sports1956activities--$502,000.19571958                            Fiscal Year 202319591960Department of Veterans Affairs, Office of National Veterans Sports1961Programs & Special Events----Grant to support rehabilitation sports1962activities--$479,000.19631964                     Disclosure of Foreign Payments19651966Paralyzed Veterans of America is largely supported by donations from1967the general public. However, in some very rare cases we receive direct1968donations from foreign nationals. In addition, we receive funding from1969corporations and foundations which in some cases are U.S. subsidiaries1970of non-U.S. companies.19711972                                 [all]