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GAO: Veterans Affairs Insurance Enrollment Standards Lacking

The Department of Veterans Affairs failed to meet insurance enrollment standards including timeliness and outreach tasks.

The VA failed to meet insurance standards, timeliness

Source: Thinkstock

By Thomas Beaton

- The Department of Veterans Affairs is one of the largest healthcare organizations that provides health benefits, but their enrollment standards and processes lead to delays and errors, according to a new report from the Government Accountability Office (GAO).

GAO analyzed veteran enrollment in VA medical centers (VAMCs) across the country and found that enrollment staff frequently did not process veterans' enrollment applications within the timeliness standard of 5 business days.

These issues were found both at VA’s Health Eligibility Center (HEC), the VA’s central enrollment processing center, and within local VAMCs that also process enrollment applications. The HEC experienced an enrollment error rate of 12 percent. The VAMCs analyzed in the report had a 27 percent error rate.

“Timely and accurate processing of veterans’ enrollment applications is critical to ensuring that eligible veterans obtain needed health care,” GAO said. “Without efficient and effective enrollment processes, veterans may be delayed in obtaining needed services or incorrectly denied benefits.”

GAO found that in March and April 2017, VAMC enrollment staff had not resolved 31 (55 percent) of the 56 pending applications within a random, non-generalizable sample of pending enrollment applications for veterans.

“Specifically we found that for 22 (71 percent) of the 31 unresolved applications there was no evidence that VAMC enrollment staff had attempted to contact the veterans to obtain missing military service or financial information, and that 18 of these 22 applications had been in a pending status for 3 months or longer at the time of our review,” GAO said.

In response to an audit recommendation from GAO, HEC officials began to prioritize a workflow to meet timeliness standards and review the amount of information required by veterans to properly enrollment for health benefits.

GAO noted that the VA lacks a standardized oversight process and reliable to monitor enrollment process in both the HEC and VAMCs, which process the majority of enrollment applications.

“Further, VHA does not have reliable data for overseeing the timeliness of processing enrollment applications at VAMCs, which process 90 percent of the applications system-wide,” GAO added.

After reviewing the GAO audit, the VA implemented other efforts across to improve their enrollment processes. GAO added a list of four recommendations that the Secretary of Veteran’s Affairs should use to direct the Acting Under Secretary of Health towards improving VA enrollment processes.

These suggestions included the development of a system-wide standard operating procedure that clearly defines the responsibilities of VAMCs towards the resolution of pending enrollment applications, and the clear definition of oversight roles for the HEC and Veterans Integrated Service Networks.

Other procedural changes as suggested by GAO involve consistent and reliable data collection and tracking that can help evaluate the timeliness of enrollment processes, an oversight mechanism to ensure VAMC and HEC guidance, and clarification of timeliness measurements.

GAO concluded their report by reaffirming the detriment to veterans’ health care poor enrollment creates, and that clear system-wide standardization can address VA enrollment inefficiencies.

“Without establishing and clearly communicating the entity responsible for oversight and the activities that should be routinely conducted, there are no assurances that oversight is being conducted system-wide and deficiencies are being addressed appropriately,” GAO said.


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