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VA Enrollment Priority Groups: Another Look

Written by veterans  |  19. July 2010

VA Enrollment Priority Groups - The number of veterans who can be enrolled in the VA health care program is determined by the amount of money Congress gives the VA each year. Since funds are limited, the VA set up Priority Groups to make sure that certain groups of veterans are able to be enrolled before others. When you apply for enrollment with the VA, your eligibility will be verified. Based on your specific eligibility status, you will be assigned a Priority Group. The Priority Groups range from 1-8 with 1 being the highest priority for enrollment. Some veterans may have to agree to pay copay to be placed in certain Priority Groups. You may be eligible for more than one Enrollment Priority Group. In that case, the VA will always place you in the highest Priority Group that you are eligible for. Effective February 2003 the VA made the decision to stop enrolling new Priority Group 8 (high income) veterans whose income exceeded VA Income Thresholds. New regulations on June 15, 2009 enabled the VA to relax income restrictions on enrollment for health benefits. While this new provision does not remove consideration of income, it does increase income thresholds. VA Enrollment Priority Group 1 Includes: Veterans with VA-rated service-connected disabilities 50% or more disabling; Veterans determined by VA to be unemployable due to service-connected conditions. VA Enrollment Priority Group 2 Includes: Veterans with VA-rated service-connected disabilities 30% or 40% disabling. VA Enrollment Priority Group 3 Includes: Veterans who are Former Prisoners of War (POWs); Veterans awarded a Purple Heart medal; Veterans whose discharge was for a disability that was incurred or aggravated in the line of duty; Veterans with VA-rated service-connected disabilities 10% or 20% disabling; Veterans awarded special eligibility classification under Title 38, U.S.C., 1151, benefits for individuals disabled by treatment or vocational rehabilitation. VA Enrollment Priority Group 4 Includes: Veterans who are receiving aid and attendance or housebound benefits from VA; Veterans who have been determined by VA to be catastrophically disabled. VA Enrollment Priority Group 5 Includes: Nonservice-connected veterans and noncompensable service-connected veterans rated 0% disabled by VA with annual income and net worth below the VA National Income Thresholds; Veterans receiving VA pension benefits; Veterans eligible for Medicaid programs. VA Enrollment Priority Group 6 Includes: Compensable 0% service-connected veterans; Veterans exposed to Ionizing Radiation during atmospheric testing or during the occupation of Hiroshima and Nagasaki; Project 112/SHAD participants; Veterans who served in a theater of combat operations after November 11, 1998 as follows -- Currently enrolled Veterans and new enrollees who were discharged from active duty on or after January 28, 2003, are eligible for the enhanced benefits for 5 years post discharge -- Veterans discharged from active duty before January 28, 2003, who apply for enrollment on or after January 28, 2008 are eligible for this enhanced enrollment benefit through January 27, 2011. VA Enrollment Priority Group 7 Includes: Veterans with income and/or net worth above the VA national income threshold and income below the VA National Geographic Income Thresholds who agree to pay copays VA Enrollment Priority Group 8 Includes: Veterans with income and/or net worth above the VA National Income Thresholds and the VA National Geographic Income Thresholds who agree to pay copays and who are: Noncompensable 0% service-connected and: (Subpriority a) Enrolled as of January 16, 2003, and who have remained enrolled since that date and/or placed in this subpriority due to changed eligibility status; (Subpriority b) Enrolled on or after June 15, 2009 whose income exceeds the current VA National Income Thresholds or VA National Geographic Income Thresholds by 10% or less, or; Nonservice-connected and: (Subpriority c) Enrolled as of January 16, 2003, and who have remained enrolled since that date and/or placed in this subpriority due to changed eligibility status; (Subpriority d) Enrolled on or after June 15, 2009 whose income exceeds the current VA National Income Thresholds or VA National Geographic Income Thresholds by 10% or less, or; Veterans not meeting the criteria above (Subpriority e) Noncompensable 0% service-connected; (Subpriority f - currently not in use) (Subpriority g) Nonservice-connected. --- Regards, Walt Schmidt

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