2. Introduction to VA Health Care
Biggest health care organization in the nation
54 hospitals in 1930, 168 medical centers and 1,053 outpatient sites today
At least one in each of the 48 contiguous states, Puerto Rico and the District of Columbia.
Roughly 60% of all medical residents receive a portion of their training at VA hospitals
Using electronic patient records since before 1985.

3. Where do our region’s veterans go for care?
CommunityBased Outpatient
Clinics
Alamogordo Northwest Metro
Artesia Raton
Durango, CO Santa Fe
Espanola Silver City
Farmington Taos
Gallup Truth or Consequences
Las Vegas

4. Eligibility for VA Health Care
To be eligible VA health care you must have:
1. Been discharged from active military service under conditions other than dishonorable.
2. If you were a National Guardsman or Reservist, you must have served the entire period for which you were ordered to active duty. It can’t be just for training purposes.
3. Served a minimum of 2 years if you enlisted after Sept. 7, 1980 or entered active duty after Oct. 16, 1981.

5. Priority Groups
VA set up Priority Groups to serve Veterans who need care the most before serving other Veterans.
Priority Groups determine co-pay status, access to some specialty services, financial test status.
Under the medical benefits package, the same services are generally available to all enrolled Veterans.

6. Priority Groups Major factors considered for group assignment:
Service-connected disabilities
Military honors/medals earned
Receipt of VA pension benefits
Medicaid eligibility
Combat operations involvement
Exposure to hazardous environments
Income

7. Income Limits
All Veterans with a compensable service-connected disability are eligible for basic health care services, regardless of income.
Income is based on prior calendar year.
Veterans may apply for hardship consideration if income changes within past year.
Income thresholds change yearly. “Geographic” thresholds by state and county.

8. Annual Income Limits (2017)
Above numbers reflect Eligible for reduced inpatient copays (80% reduction) and Cost Free Medical Care.
10% above require copayments
County
Veteran Only
+1 Dependent
+2 Dependents
+3 Dependents
Bernalillo
$34,550
$39,450
$44,400
$49,300
Lincoln
$29,100
$33,250
$37,400
$41,550
Santa Fe
$36,200
$41,400
$46,550
$51,700
Socorro
$28,400
$32,450
$36,500
$40,550

9. Core Skills Integration: J/K student Guide
How to Apply for Care
Complete VA form 10-10EZ. Get form by visiting, calling, or writing any VA health care facility or Veterans’ benefits office. Can also call toll-free VETS ( ) or get online at
VETERANS MUST BE ENROLLED TO USE VA HEALTH CARE BENEFITS
Mention they may have a co-pay and reference benefits book page 6
Did NOT address priority groups (book page 12)

10. VA Medical Services
Outpatient and Inpatient medical, surgical / specialty and mental healthcare.
Prescription drugs, including over-the-counter drugs.
Bereavement counseling for immediate family members.

11. VA Medical Services Comprehensive rehabilitative care.
Durable medical equipment and prosthetic and orthotic devices.
Optometry exam and hearing exam
Pregnancy and delivery care
Decedent benefits, including memorial flags, headstones, burial allowance, etc.

12. Extra Qualifications or Authorization
Services Requiring
Extra Qualifications or Authorization
Home health care services.
Respite, hospice, and palliative care.
Payment of travel and travel expenses for Veterans.
Emergency care in non-VA facilities, if authorized.
Hearing aids, visual aids/eye glasses
Dental care (to eligible Veterans)

13. Copayments apply unless:
Veteran is 50 % or more SC
Treatment is for a service-connected condition
Veteran’s income is less than the VA pension rate/annual household income thresholds established by Congress

14. Copayments for Medications
Medication Copayments changed to a tiered system effective February 27, 2017.
Tier 1 drugs (preferred generics) $5
Tier 2 drugs (non-preferred generics) $8
Tier 3 drugs (brand name drugs) $11
(Veterans in Priority Groups 2 through 8 are limited to $700 annual cap)

15. Copayments for Outpatient Services
Basic Care Services (PCP) $15 / visit
Specialty Care Services $50 / visit
Copayment amount is limited to a single charge per visit regardless of the number of health care providers seen in a single day. The copayment amount is based on the highest level of service received.

16. Copayments for Inpatient Services
Priority Group 8
Inpatient Copay for first 90 days of care during a 365-day period $1,316 / each additional 90 days of care during a 365-day period $658 / Per Diem Charge $10/day

17. Copayments for Inpatient Services
Priority Group 7
Inpatient Copay for first 90 days of care during a 365-day period $ each additional / 90 days of care during a 365-day period $ / Per Diem Charge $2/day

18. VA Care and Other Health Plans
VA is required by law to bill any health insurance company that provides coverage for Veterans, except for service-connected issues, including policies held by a spouse.
Money recovered is a necessary part of the New Mexico VA operating budget.
VA does NOT make the Veteran pay more than what is collected from the insurance company.

19. Authorized Non-VA Care 38 U.S.C. 1703
Available to Veterans under specific circumstances. (after clinical and administrative review)
Must be pre-approved (except for emergencies, notice of hospitalization must be given to the VA with in 72 hours).
May include inpatient or outpatient care.
Consult VA’s Non-VA Care department to determine specific eligibility.

20. Who Qualifies for Choice Program
You are eligible if any of these situations apply to you:
You have been (or will be) waiting more than 30 days for VA medical care CID
You live more than 40 miles away from a VA medical care facility or face one of several id excessive travel burdens.
The VA can not provide the care. (Non-VA)

21. Authorizations for Choice
Must be pre-authorized by VA based on eligibility and clinical criteria
Care must be considered medically necessary, and within the scope of VA medical services
Veterans must call the Choice Program Call Center to “Opt-In” for care and arrange non-VA appointments
Treatment includes any follow-up appointments, as well as any ancillary and specialty services
Emergency care and urgent care not included.

22. Important VA Numbers toll-free: (800) 465-8262
New Mexico VA (505) or
toll-free: (800)
Enrollment Office Ext: 2741
Enrollment Fax (505)
Non-VA Care Ext. 2707
Caregiver Hotline
Veterans Crisis Line
Homeless Veterans Call Center
Veterans Benefits
Choice Program Call Center

23. Additional Information
VA Healthcare Benefits:
VETS (8387)
Burial & Memorial Benefits:
New Mexico VA Healthcare System:
(800) (Enrollment: ext. 2741)