Expanding Choice Program eligibility

What changes in the 40-mile calculation mean for Veterans


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On Tuesday, VA Deputy Secretary Sloan Gibson announced a change in the Veterans Choice Program that nearly doubles the number of individuals eligible to participate under the 40-mile criteria.

“We’ve heard what Veterans are saying about the Veterans Choice Program and the current method of determining eligibility based on how the 40-mile distance is calculated,” Gibson wrote here on Vantage Point. “We are going to change that.”

VA announced it will change the calculation used to determine the distance between a Veteran’s residence and the nearest VA medical facility from a straight-line distance to driving distance. The policy change will be made through regulatory action in the coming weeks.

For example, under the new distance calculation, a Veteran who lives less than 40 miles “as the crow flies” – or straight-line – from the nearest VA medical facility, but who needs to physically drive more than 40 miles to get there would be eligible for the Veterans Choice Program. Under the previous straight-line distance calculation, this Veteran would not be eligible for the program unless they were waiting for an appointment longer than 30 days from their preferred date or the date determined to be medically necessary by their physician.

Will the change in the 40-mile rule impact you? Here are answers to some of the questions we’ve been asked.

Q: When will this expansion go into effect?
A: VA must publish an interim final rule-making and this change will be effective upon publication of this rule-making in the Federal Register.

Q: How does VA plan to notify newly eligible Veterans?
A:  Because all potentially eligible Veterans should already have received their Choice card, VA will send letters notifying Veterans who will be eligible under the revised mileage calculation. If you have not received your Choice card, please call 1-866-606-8198.

Q: What mapping tool is used to calculate the 40 miles?
A: The tool used will be a commercial product that is consistent with VA’s long-established beneficiary travel program. As every commercial product uses priority programming, the results may vary among products.

Q: Is it still 40 miles from any VA medical facility or is it 40 miles from a VA medical facility that actually provides the care needed?
A: This is currently defined as any VA medical facility. Absent a statutory change, VA does not believe that it has the flexibility to adopt an alternative approach. In other words, the law is clear that eligibility must be based on the distance from the Veteran’s residence to any VA medical facility, even if that facility does not offer the specific medical service the Veteran requires for that particular visit. VA is working with Congress, VSOs and Veterans like you to make changes to the law so that it works for all Veterans. In testimony Tuesday, March 24, before the U.S. Senate Committee on Veterans’ Affairs, VA Deputy Secretary Sloan Gibson answered a question about the 40-mile requirement as written into the law by Congress. Watch his response below or watch the full hearing online.

Q: Why is VA changing this criterion now?
A: The interim final regulation was based on the discussion in the House Conference Report that accompanied the Act. After further review of other information contained in the report, VA believes that revising the calculation will still be in the spirit of the law and allow improved access for Veterans.

Q: Where can I get more information about the program?
A: Visit the VA Choice website at http://www.va.gov/opa/choiceact/ and watch the video below.

 

Author

Megan Moloney

— Megan served at VA from May 2013 to July 2018. She is the daughter, granddaughter and spouse of Army and Navy Veterans who served in World War I, World War II, Korea, Vietnam, Iraq and Afghanistan.

Comments

  1. jon eden    

    I live within one mile of tihe va clinic in Bozeman, MT–one that does not do colonoscopies. The VA wants me to travel 130 miles to Billings, with a colon full of fluid that I assume I will be discharging along the way. I think not.

  2. Clay Vagnini    

    The VA Pensacola Optometrist determined that I needed cataract surgery and wanted to schedule the procedure with the Biloxi VA facility. I had been issued my Veterans Choice Card so I opted to get the surgery locally because Biloxi Ms is 188 miles from where I live. It could not have gone any better. The Biloxi Choice management consultant called me and let me know of several cataract surgery clinics in my area. They coordinated with the local surgery clinic who called me to schedule the consulting and procedure appointments. The physician wrote the necessary prescriptions which were sent to my VA primary care physician and filled by the VA pharmacy and mailed to me. It took 1 week to get me in to see the surgeon and 1 week later, I had the surgery. From the initial determination requiring the surgery to actually having the surgery was less than 3 weeks. I can’t say enough good things about the whole process. Thanks VA!!!

  3. Juan    

    I’m 100% P&T with 40% from my lower back I tried for 2 weeks to get in touch with pain management due to a terrible pain on my back, centralize appt have appt for Friday 8:00am I was need the treatment asap, my va hospital is 65 miles away, can anyone help me on what can I do? Please!

  4. Gatchel E. Watson    

    My Problem with the Choice Care was my Primary Care is 60 miles away,but even though there is another Clinic 20 miles from me that isn’t my Primary Care I was ineligible.The waiting list to go to the Clinic 20 miles away was 3 Years back then.Even if the Miles away was Shortened I would still be ineligible because the Clinic thats 20 miles away isn’t my Primary Care Clinic.After I called the Number and Checked on my eligibility She said Sure you should be able to go to your Local Hospital for Care.Then She said I was ineligible Because of the Clinic thats not my Primary Care and I can’t go to it.She said that was the Senate that did that.

  5. Sarah Rowlett    

    There is a VA clinic within the 40 mile radius however they cannot treat in an emergency situation or do any women’s appointments. The closest VA Hospital is about 100 miles away. I am having heart problems and went to the hospital in town, not a VA hospital, the VA Fee basis refuses to pay for that ER visit and I was told I should get in my car and drive 100 miles to the nearest VA Hospital while I’m having tachycardia, pain in my chest, shortness of breath and dizziness. The VA Clinic in Cookeville, TN is a joke. I have had 10 primary care doctors since November 2007. They really need to get all this in order. Currently the VA health care system is a joke.

  6. David Fleming    

    I need glasses, Fredericksburg is a clinic ,so I have to go to Richmond, VA. over 100 miles one way, and veterans choice cant do a thing for me. What good is it ?

  7. Carol    

    This should bring some kind of relieve on the heavy schedules Dr’s at VA have; I am one of the veterans that complain on the poor care most of us receive. In fact, i agree with most of the veterans that are commenting that they go to a VA Dr. that doesn’t even touch them. I live in PR and my VA facility gives me a big headache to receive the treatment I need and the good care I used to have in Texas. I have to say that if i could afford treatment out of VA i will totally do it, but unfortunately here in PR it’s very hard to afford care out of VA. I wish things change. Many veterans like me that have a constant chronic pain, think about committing suicide, because we can’t stand the pain. I think I am being discriminated for being young, have to take monthly urinalysis because I am prescribed opioids, for some reason I don’t know, the opioids don’t show on my test which is something really makes me rethink the fact of trusting VA labs, because I take my medicines as prescribed and have my husband as my witness. So, this month my Dr refuses to prescribe me pain killers, I have severe muscle spasms, headaches, hand and feet numbness, fibromyalgia, back condition, and all of this pain keeps me from having a close to normal live, so yes, there are days where I just feel like taking my life will relieve the pain. 🙁

  8. Michael moore    

    How do you get meds,filled in this,program. I was approved to see a civilian Dr and he prescribed me meds but I have to pay for them. At 60% I should not have to be pills. Does anyone know how to get them or how it works.

    1. Michele F. Stewart    

      Take the prescription to your Prime care, they should be able to fill the prescription or something similar.

  9. Pauline Clugston    

    Our story is the same and it is the main issue. Valuable care in a reasonable amount of time. How can they, with any pride for the veterans who have been so faithful, pretend that the “any VA facility within 40 miles” solves any issue with this supposed benefit? Most VA facilities do not provide complete services and no we cannot change our primary care provider to a closer facility. I have driven my husband over 170 miles one way, some times multiple times a week for him to receive care. I have said that I am willing to do that for him to receive the best care for him BUT there are times for minor care, like changing bandages, it is ridiculous for us to spend up to 8 hours traveling. There just has to be a better way.

  10. Harold D. Powell    

    How about after hours and holidays and weekends? When the only care is hospital on the outside? It comes out of our pockets!

    1. Michele F. Stewart    

      Go to your VA emergency room, they are available. If you have to go to a Civilian emergency room have them bill your regional VA. I did that once & it worked just fine & VA paid the entire bill. Don’t forget to notify your Region VA that you had to go to the emergency room. I always carry a card with my Regional VA address & phone #.

  11. Cheryl McDaniel    

    I have quite a few health issues that consist of a birth defect and others due to age related, family history and accidents/injuries. My biggest problem is that I live in Marshall, AR and the NEAREST clinic is Harrison (roughly hour drive one way and a doctor that I feel uncomfortable with and don’t like) so my Primary Care Clinic is in Conway (roughly 1 1/2 to 2 hr. drive one way) with nearest Medical Center In North Little Rock (an additional 15 to 30 mins. more driving). My back issues are Spina Bifida and fractured and compressed T8 vertebrae in addition to severe osteoporosis, arthritis and various other issues throughout my entire body and being in a vehicle for long periods put me in excruciating pain so that I rarely go to doctor even when I have appointment and/or have new issue which may or may not be serious but should be checked out just in case. (Also, no vehicle of my own so have to find transportation with someone else.) If I had doctor, hospital, etc. closer might be more prone to get needed health check ups and/or go to get illness/injury that occurs checked to see if serious and need further help or not.

  12. Jerry Nissen    

    Good luck, I just spent 6 months and 52 phone calls just to get an appointment, this system is a joke. They authorize you, say wait 5 days to hear from us and no one ever calls back. And you never talk to the same person

  13. Brent J Harris    

    I have the same issue as stated above. I go to the VA for a bad back (and deteriorating quickly) and see a chiropractor. My round trip is nerly 5 hours and only hurts my back. I spend money out of packet to see a chiropractor in my home town that I can visit during lunch during work, instead of having to take a whole day off and spend 5 hours in a car. The new 40 mile rule should apply towards what service you’re seing. I have a small general health clinic within 20 miles, but they can’t treat any of my issues, and if my back gets worse, I have to drive to a different state completely to get the next level of treatment for my back. That then becomes almost a 7 hour round trip, only to hurt my back more.

  14. harry campbell    

    The 40 mile isnt the problem. The problem is the facilty in Greenville NC that isnt completely staffed and has been that way over a year. If you have a cold you cant even get in to see your primary doctor or you go on your own to the hospital for which Va wont pay for it or drive one way to the VA in Durham where they have a ER . One way is 109 miles from me. When they built the facilty in Greenville Nc it also had a ER built so Vets could get help there but as of today that isnt staffed. My question is why buld something and not use it. I tried the new card to get approval and they said I live close to the Greenville Nc facilty. I guess I will just die trying to get to Durham. By the way I am a Heart patient and have had 7 heartattacks. One more thing is trying to get a colonoscopy done. I am over due one but seems that all they do in Durham is talk and ask questions and then ram a finger in you and say you are okay.

  15. Sharon Crall    

    We live over 135 miles from Ann Arbor. My husband goes there for arthritis treatment. It took us 2 1/2 hours to get there. The doctor spent approximately 5 minutes with my husband and never even touched him! Just talked to him! 5 minutes! There are doctors in Grayling that could see him. Until they get serious…. we can just assume this is another delay tactic to keep the veterans hoping for real help!

    1. Bill Hughes    

      Problem is I live less than 40 miles from a VA Clinic but all the staff can do there is take your vitals and ask you a few questions; then it is wait a month to get an appointment in Saginaw (140 miles), Ann Arbor (120 miles or Detroit (220 miles) to see a specialist or have any test more than a blood or urine test.

  16. Leslie Alan Peterson    

    THE 40 miles is not my problem, no DR accepting the VET within 60 miles is the problem.

    1. Patrick jahnke    

      U know I maybe within 40 miles the va doctor refused to CCC me listen, then I hear bs from other. So call so call pain specialist it in ur head!!!!!! Know I seen some one else told change tens unit to my back from leg pain, I had nerve block 2 yr it didn’t help , I don’t understand I did ask yrs ago is thier any other plc I could place they said no. Know thier is? I do not who to believe , what do I do when I have pain at 2 am? 4 am . suffer why did she used flip cards? She did not even touch or look at it it all talk it in my head!!!!!!!!

    2. David Bowers    

      This is but ONE change that needs to be implemented … immediately! This program is so fraught with confusion, mis-communication and failure that it’s absurd.

      I know of many Vets who have been going round and round between the VA and the Veterans Choice program trying to get approval for services. The VA people (at least in AZ) do not know how to properly address the program and the Choice people do not know how to communicate to the VA.

      I myself have been going back and forth with them for going on three months trying to get approval for cataract surgery locally, instead of 200 miles away at the nearest facility in AZ that has the service available. Every week it’s the same thing: VA cannot get me the service I need within specifications and tells me to contact Choice; Choice tells me they either don’t have the info they need from VA or it was incorrectly submitted and for ME to contact VA. I contact VA and they assure me it’s being handled and to contact Choice … and so on, back and forth with no resolution. This particular example has been going on since mid-January.

    3. Ovetta Coleman    

      This still does not help veterans like me who has a VA Clinic within 40 miles, but have to travel to Pensacola or Biloxi for specialized care. I have Graves Disease and I was approved for 1 visit to a civilian Endocrinologist that was scheduled for Jan 8th. That doc ordered an iodine uptake test. . I first learned of the possibility of Graves Disease in Oct. 2014.by my primary care physician in Mobile. I then saw an endocrinologist in Biloxi on Feb.23th 2015. The test the civilian doc. ordered was done on March 2nd and 3rd. I will not see another endocrinologist until April 30 in Pensacola. I am so glad that this condition can be treated. Because if it couldn’t, I would be in serious trouble now.

    4. robert gieringer    

      iam in punta gorda fla the va clnic in cape coral would not grant me dual primary care doctors so the results were I could not be treated there for my diabeties was told I have to wait till go back to maine mean while mu sugars are 250 so what do I do

    5. VIVIAN    

      HALLELUIA!! what a deal… it is so welcomed and thank you.. we were the ones in the crack of the crow… thank you VA for this small but yet win for the vets..
      sincerely
      vee

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