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VA health care: Enrollment priority groups

Today’s veterans have a comprehensive medical benefits package, which VA administers through an annual patient enrollment system.

The enrollment system is based on priority groups to ensure health care benefits are readily available to all enrolled veterans.

Complementing the expansion of benefits and improved access is our ongoing commitment to providing the very best in quality service. Our goal is to ensure our patients receive the finest quality health care regardless of the treatment program, regardless of the location.

Enrollment in the VA health care system provides veterans with the assurance that comprehensive health care services will be available when and where they are needed during that enrollment period.

Priority group, definition

Group 1.

• Veterans with VA-rated service-connected disabilities 50 percent or more disabling.

• Veterans determined by VA to be unemployable due to service-connected conditions.

Group 2.

• Veterans with VA-rated service-connected disabilities 30 or 40 percent disabling.

Group 3.

• 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 percent disabling.

• Veterans awarded special eligibility classification under Title 38, U.S.C., §1151, “benefits for individuals disabled by treatment or vocational rehabilitation.”

• Veterans awarded the Medal Of Honor (MOH).

Group 4.

• Veterans who are receiving aid and attendance or housebound benefits from VA.

• Veterans who have been determined by VA to be catastrophically disabled.

Group 5.

• Nonservice-connected veterans and noncompensable service-connected veterans rated 0 percent disabled by VA with annual income and/or net worth below the VA national income threshold and geographically-adjusted income threshold for their resident location.

• Veterans receiving VA pension benefits.

• Veterans eligible for Medicaid programs.

• World War I veterans.

Group 6.

• Compensable 0 percent 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 the Republic of Vietnam between Jan. 9,1962, and May 7,1975.

• Veterans of the Persian Gulf War who served between Aug. 2, 1990, and Nov.11, 1998.

• Veterans who served in a theater of combat operations after Nov. 11, 1998, as follows: Currently enrolled veterans and new enrollees who were discharged from active duty on or after Jan. 28, 2003, are eligible for the enhanced benefits for five years post discharge. Note: At the end of this enhanced enrollment priority group placement time period, veterans will be assigned to the highest priority group their unique eligibility status at that time qualifies for.

Group 7.

• Veterans with gross household income below the geographically-adjusted income threshold (GMT) for their resident location and who agree to pay copays.

• Veterans with gross household income above the VA national income threshold and the geographically-adjusted income threshold for their resident location and who agrees to pay copays.

Group 8.

Veterans eligible for enrollment: noncompensable 0 percent service-connected and:

Subpriority a: enrolled as of Jan. 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 percent or less. Veterans eligible for enrollment.

Subpriority c: enrolled as of Jan. 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 percent or less. Veterans not eligible for enrollment: Veterans not meeting the criteria above.

Subpriority e: noncompensable 0 percent service-connected (eligible for care of their SC condition only).

Subpriority f: Nonservice-connected.

As you can see, the above priority groups can be quite confusing. In order to verify eligibility requirements, the best answer is to come by the office and we will go through your record. If you are eligible for VA health care, you should consider enrolling.

Trust Fund

The Trust Fund Grant has directed a change of rules. All requests for travel/lodging reimbursement must have the following: Printed copy of appointment, copy of receipt for gas payment and/or receipt of lodging payment. Payment from Trust Fund will be to the amount on receipts: No receipt-no payment.

Ensure you apply for travel through VAMC Albuquerque, whenever possible.

If a veteran is eligible for VA Travel payments, no reimbursements are authorized through the Trust Fund Grant.

Benefits

For information on VA benefits, call or stop by the Archuleta County Veterans Service Office, located at the Senior Center in the Ross Aragon Community Center.

The office number is 264-4013, fax number is 264-4014, cell number is 946-3590, and e-mail is raytaylor@archuletacounty.org. The office is open from 8 a.m. to 4 p.m., Monday through Friday. Bring your DD Form 214 (Discharge) for applications to VA programs or benefits for which the veteran may be entitled to enroll, and for filing in the Archuleta County VSO office.

Meetings

The following veterans groups meet in Pagosa Springs:

American Legion Post 108: second Wednesday of the month, 7 p.m., 287 Hermosa Street.

Veterans for Veterans: every Tuesday, 10 a.m., Quality Inn.

Women’s Group of Spouses of Veterans: every other Monday, 6 p.m., St. Patrick’s Episcopal Parish Hall, 225 S. Pagosa Blvd. Contact Charlotte, 731-1025.

Point Man Ministry (veterans): every Thursday, 9 a.m., Buffalo Inn.

Contacts

Durango VA Outpatient Clinic: 247-2214.

Farmington VA Center: (505) 327-9684.

The Veterans Crisis Line offers free, confidential support to veterans in crisis, as well as their family and friends 24/7, 365 days a year. Call (800) 273-8255, chat online, or text 838255.

This story was posted on November 29, 2012.