▶ 0:39:58This uh oversight hearing of the subcommittee on health will now come to order. Uh the chair may declare a recesses at any point. That was when we were anticipating votes. Um I'd like to welcome all the members and the witnesses to today's hearing. Many here today have likely heard that the VA has taken significant steps to improve the civilian health and medical program of the Department of Veterans Affairs, CHAMP VA.
▶ 0:40:21Champ VA is a program to provide earned benefits for veterans families whenever the veteran has qualifying service connected disabilities or death. A veteran spouse or child can access a range of covered health services through Champ VA, inpatient and outpatient care, prescription drugs, mental health services, skilled nursing care, uh, and others. Champ v uh VA is a way that we honor our commitment to uh, serving the veterans and their families who are injured in the line of duty.
▶ 0:40:48Sometimes circumstances require that family members forego a full-time job with health insurance benefits so they can care for their veteran uh, full-time instead. These caregivers consider Champ VA a lifeline. Decades ago, Congress created Champ VA to close a gap left by Triricare. Champ VA, when it works, is a huge relief for veterans and their families. Affordability is on everyone's mind, and that is especially true for veteran families with serious medical needs.
▶ 0:41:14Fortunately, the VA has recently taken steps to ensure Champ VA works. I'm pleased that the Trump administration is pulling out all the stops to bring down the cost of living by putting families first. Just before Thanksgiving, Secretary Collins announced the elimination of Champ VA application backlog. That's over 60,000 more families who can now access caregiver health care benefits at the VA. The subcommittee appreciates the VA's work to modernize Champ VA.
▶ 0:41:41Online applications and claims should have been available a long time ago, but if we continue to hold the VA accountable, veterans and their families will see greater results. As a case in point, I'm particular please particularly pleased that the VA is in the process of developing a CHAMP VA provider directory. This is after an abundance of feedback from members of Congress to the VA about the difficulty that beneficiaries have even finding someone who will accept Champ VA.
▶ 0:42:09The committee has been diligent in exploring solutions for a provider directory. I want to check thank my friend and colleague oversight committee chairwoman Jen Kiggins for her leadership on this issue as she recently wrote a letter and introduced legislation to create this system for veterans and their families. Needless to say, we'll we'll continue um to exercise oversight to ensure that the Champ VA directory is fully implemented. Modernization like this and Champ VA's ongoing efforts enhances the convenience of using the Champ VA program.
▶ 0:42:40And now VA can process applications and claims faster than they have uh in the past. I'm encouraged that the VA is now aiming to process 100% of electronic claims within 30 days. It should be noted uh that in the past their stretch goal was to process 90% of electronic claims in that time. However, there are still um obstacles and opportunities for this program. Navigating VA bureaucracy is never easy.
▶ 0:43:05I have heard that certain obstacles remain in Champ VA and I expect our witnesses to highlight these issues today. Foremost, this subcommittee will do its part so that the VA can process 100% of all claims within 30 days, not only the electronic ones. Paper claims still take too long to process. I know delays are inherent and manual processing is tedious, but I look forward to working with the VA to speed up paper processing as well.
▶ 0:43:31Second, there is limited transparency for status updates on applications or claims request. Spouses and children want to know what's going on with their application. Caregivers and providers want to know whether their claims will be accepted or denied. Whenever they hear radio silence from the VA, they lose trust in the VA.
▶ 0:43:49This this uh subcommittee spoke with one large healthcare provider who shared that the VA assigned a direct representative to address their claims questions, but the direct representative was too overwhelmed to ever timely resolve the provider's questions. The provider would have to wait months just to get questions answered. And speaking as a veteran and a provider, I want to ensure this provider's experience is a thing of the past. There must be a better way to get information for families and providers so they know exactly what their benefits are ahead of time.
▶ 0:44:20Third, the VA could resolve claims faster if it improved its ability to cross reference a spouse or a child's health insurance and whether that person reached his or her deductible. Because Champ VA can function as either a primary or a secondary payer, providers must properly bill either the program or somebody else's health insurance first. Unfortunately, this coordination frequently breaks down and providers lose time filing the claim only for the VA to require a different form.
▶ 0:44:48It's also important to know in real time whether a spouse or child has reached the deductible. Right now, real-time knowledge is unavailable to claims processors. I'd like to see that change. Lastly, some aspects of the Champ VA process create snags for caregivers that limit the program's use. The subcommittee has heard most about the fact that Champ uh VA identification cards are in fact not cards. They are strips of paper. Uh Mrs. Benson so clearly explained the issue when she showed this subcommittee her own card.
▶ 0:45:18She explained that if anything happens to the card, meaning paper strip, like if somebody accidentally spills a drink on it, it's never happened to anybody in this committee or in the audience. Um, the caregiver must wait for another strip of paper from the VA. Caregivers should not have to ask their neighbor for a laminator to avoid damage or destruction to their healthcare paperwork.
▶ 0:45:42I hope this discussion sheds light on these concerns and opens the door to further discussions on how we continue to modernize Champ VA and have it work better for veterans and their caregivers. Just like every other American family, veteran families with caregiving responsibilities set aside this time of year to give their thanks to God, celebrate one another, and enjoy tradition. But caregivers must also balance the healthcare demands to ensure that they and their loved ones in need enjoy the season to the fullest.
▶ 0:46:09Our goal with this hearing is to make Champ VA work as it's intended to serve veterans families. Finally, I'd like to thank beneficiaries like Mrs. Vincent and many others from groups like Senator Elizabeth Dole's Foundation for sharing their stories and bringing Champ VA's issues to us. I now yield to Ranking Member Brownley for any open remarks she may have.
▶ 0:46:27Thank you, Madam Chair, and and thank you to our witnesses for being here today and apologize for the waiting that you had to undergo, but I'm glad to have an opportunity to examine the Champ VA program and the significant opportunities for improvement in VA's administration of this program. I'd first like to note that the committee staff have not received a briefing from VA's Office of Integrated Veteran Care since December of 2024, a whole year ago.
▶ 0:46:57I hope you agree, Madam Chair, that this is wildly unacceptable, especially considering this office is responsible for administering community care programs that account for more than $40 billion per year in VA expenditures. Committee staff used to receive briefings from this office every other month. I'm very concerned that under the Trump administration, these briefings have completely stopped.
▶ 0:47:23JVA is just one of the programs the office of integrated veteran care admin admin administers and it's my understanding that they were working on a number of initiatives to improve this program throughout 2024 but we have received no updates in nearly a year.
▶ 0:47:41I'm glad VA officials are here today to share their recent progress, but it's clear from our other witnesses testimony that far more remains to be done and we need more regular oversight of the Champ VA program.
▶ 0:47:55Whether it's the lack of online self-service tools for applicants, enroles, and providers, the lack of a formal provider network or online provider directory, or the lack of transparency for beneficiaries and providers about allowable payment rates. There are many ways that Champa could work better for beneficiaries and providers. As many of you know, I have long been a proponent of reforms for Champ VA.
▶ 0:48:23I strongly believe my legislation to allow dependents to remain enrolled until they turn 26, regardless of school enrollment is necessary to ensure parody between Champa and most other health insurance plans. However, in previous testimony about my Champ VA bill, VA indicated that it does not view Champ VA as an insurance plan, but as a medical care benefit.
▶ 0:48:52As I said then, if it walks like a duck and swims like a duck and quacks like a duck, it's probably a duck. Champier has co-pays, annual deductibles, and maximum out-ofpocket costs. It has a formulary. Champ VA requires prior authorization for certain services. It counts as minimum essential coverage under the Affordable Care Act. If that's not health insurance, I don't know what it is.
▶ 0:49:20VA needs to decide if it wants to continue to force caregivers and families of veterans to navigate a system that has all of the complexities and frustrations of health insurance and places all the burden of navigating that system on beneficiaries. or if it if it wants to provide the loved ones of fallen and severely injured service members and their caregivers of our most vulnerable veterans with the best support and health care benefits possible.
▶ 0:49:51That's that's my choice. Miss Benson, I'm glad we have you here today to speak about your own experiences as well as your work with a code of support foundation helping other families and caregivers navigate this system. It's clear from your testimony that you are well-versed uh in this program and how to navigate it.
▶ 0:50:12But VA should not be relying on beneficiaries to recruit pro providers, determine what codes will allow VA to process claims, and know every step of a complex appeals process. The way the system is currently set up, it seems you need endless hours of free time and the equivalent of a PhD and health insurance just to make sure your family can get covered for the care you need. This obviously is not acceptable.
▶ 0:50:41I believe it's clear to everyone in this room that there is a there is massive room for improvement in the CHAMP VA program. This hearing is a good step at providing insight and oversight, but I hope it won't end here. and I thank you. And Madame Chair, thank you for the hearing and I yield back.
▶ 0:50:59Thank you, uh, Ranking Member Brownley. I'd now like to introduce our witnesses who have been very patient through this process. So, thank you again. Testifying before us today, we have Dr. Maria Lorente, acting assistant under secretary for health at the Office of Integrated Veteran Care at the VA. She is supported by Mr. David Fenel, director of veteran and family member programs, including Champ VA. Mrs. Cara Benson, veteran support and strategic initiative specialist at the Code of Support Foundation.
▶ 0:51:28She is also a CHV VA beneficiary. And Mr. Jim Zenner Zenner, excuse me, National Policy Director for the National Association of County Veteran Service Officers. Dr. Renta, you're now recognized for five minutes to present your testimony.
▶ 0:51:43Thank you, Chairwoman Miller Meeks, Ranking Member Brownley, and distinguished members of the subcommittee. Thank you for the opportunity to testify today about the civilian and medical program of the Department of Veterans Affairs or CHAMP VA, a vital program that provides healthc care coverage to eligible spouses, children, survivors, and caregivers of qualifying veterans. Joining me today is Doc, Mr. David Finel. He's the director of veteran and family member programs in the office of integrated veteran care.
▶ 0:52:12Champ VA plays a critical role in supporting the families of veterans who've made profound sacrifices in service to our nation. My testimony today will provide an overview of the program's eligibility criteria, current operations, recent improvements, and opportunities for continued collaboration with Congress to ensure timely, efficient, and equitable access to care. Authorized under the United States Code Title 38 section 1781.
▶ 0:52:40Champ VA provides health care coverage to eligible spouses, surviving spouses and children of veterans who are permanently and totally disabled due to a service connected disability or who died as a result of a service connected condition or who died while rated permanently and totally disabled from a service connected condition.
▶ 0:53:01It also covers certain survivors of members who died in the line of duty and certain primary family caregivers under the program of comprehensive assistance for family caregivers. To be eligible for Champ VA, the individual cannot be eligible for Triricare. As of November 2025, Champ VA provides healthc care coverage to more than a million beneficiaries.
▶ 0:53:23The program receives approximately 4,000 new applications every week, and more than 90% of medical and pharmacy claims are now processed electronically within days of receipt, ensuring timely reimbursement and continuity of care. Under the leadership of Secretary Collins, and thanks to recent reforms, the application backlog, previously exceeding 70,000 cases, has been eliminated. New applications are now processed in a matter of days.
▶ 0:53:54The appeals backlog has also been reduced from over 20,000 to approximately 1,000 with continued progress underway. These improvements reflect Department of Veterans Affairs commitment to veteran first service delivery, accountability, and efficiency. Under the last administration, Champa faced significant delays in application and appeals processing due to increased demand, staffing constraints, and reliance on legacy manual systems.
▶ 0:54:24Some applicants waited over 150 days for Under Secretary Collins leadership, VA implemented a two-pronged strategy, authorizing overtime for application processors and introducing enhanced process engineering and new automation to streamline workflows. These actions have assured timely access to benefits for eligible Champ VA beneficiaries.
▶ 0:54:51VA is modernizing Champ VA operations to reduce bureaucracy and improve the user experience. In December 2025, we will complete the transition to a more automated application processing system, increasing efficiency and reducing manual workload. These efforts align with VA's broader digital transformation strategies, and support the department's goals of transparency, reduced administrative burden, and improved outcomes for veterans and beneficiaries.
▶ 0:55:22Access to accurate provider information is another area of focus. Although Champ VA beneficiaries may see any provider who accepts Champ VA's allowable rates, VA acknowledges that beneficiaries may experience difficulty identifying participating providers or confirming whether a provider is accepting new patients.
▶ 0:55:42We're working to improve how provider information is presented and maintained, including updating publicly available guidance and strengthening communication with providers who build Champ VA. We appreciate with the continued interest in strengthening Champ VA. Over the last few months, VA has made significant strides in eliminating backlogs, modernizing systems, and improving access.
▶ 0:56:07We remain focused on delivering timely, high-quality service to those who have sacrificed so much. This concludes my statement and we look forward to responding to any questions that you may
▶ 0:56:20Thank you. Uh Dr. Lorente, Mrs. V Ben Vincent, you're now recognized for 5 minutes to present your testimony.
▶ 0:56:27Chairwoman Miller Meeks, Ranking Member Brownley, and members of the House Veteran Affairs Subcommittee on Health, thank you for inviting me to testify today. It's my honor to return to further the discussion on the inefficiencies and inequalities within the Department of Veterans Affairs Champa Program. At the Kota Support Foundation, we work with veterans and their families every day. Our digital resource hub, Patriot Link, has served over 67,000 military community members to find needed supports and resources.
▶ 0:56:50Our case management team has already worked with over 1300 family members this year to navigate local, regional, national, and government partners to achieve stability through needed financial, social, physical health, and mental health supports. But I'm not just here as an employee. I'm here as a caregiver, an advocate, and Elizabeth Dolph Foundation fellow alum and a Champa user. I care for my husband who deployed twice to Iraq as a combat engineer between 2003 and 2006.
▶ 0:57:14My husband suffered multiple traumatic brain injuries during his years of service complicated by toxic and sephylopathic process most likely due to chemical exposure. My five children and I enrolled in Champa in 2017 when my husband was awarded permanent and total status for a service connected injuries. We breathed the sigh of relief knowing that we would have the safety net of health care for myself and our children, three of whom have needed specialty medical care through the years. I testified in June of this year to the stub committee about the nightmare navigating Champa has been for our family.
▶ 0:57:41Highlights of that nightmare include having to sign a $110,000 promisary note to ensure a needed hospitalization occurred in the chance that Champa refused payment and being sent to collections when Champa claims payments didn't occur in a timely manner with one provider waiting over 27 months for payment. Champa's appropriate care has felt anything but appropriate. I'll not rehash my earlier testimony. I know the committee is interested in how the situation looks for Champa today. Um its changes if changes have been made and how those changes have been received since my last testimony.
▶ 0:58:11I commend VA for finally clearing the Champa application backlog. It is beyond time to process applications in real time. I was also overjoyed to hear that claims being submitted electronically are being paid quicker than previously. Yet, even with that good news, the situation on the ground for Champa users remains murky. While the application backlog is cleared, only two families I know waiting on their decisions have received notifications of such to date. Provider acceptance of Champa still remains a challenge.
▶ 0:58:36I had a medical complication this year which required me to travel over an hour for outpatient procedures as they were the nearest willing provider to file. I still pay out of pocket for my children's mental health providers as we have yet to find a provider who accepts Champa mental health for kids. I know I'm not alone. At code of support, one of our most frequent requests is mental health supports for dependents. We have multiple national and regional providers we work with for those supports. Five take tryare and refuse to take cha. To quote one, VA is too difficult to work with.
▶ 0:59:04It's hard to place blame on the providers for declining Champ VA. Indeed, VA has made it difficult on providers filing claims and on users looking for providers. Lack of a provider network and published fee schedules, unclear claims filing processes, and var varied claims payment times contribute to the difficulties. Appeals for denied coverage under Champa are difficult to navigate as well. A Champa enrolle recently had her child's claim for an ambulance ride during an anaphilaxis event denied. It took us an hour of digging through claims denial letters, EOBS, and CPT codes to understand what had happened.
▶ 0:59:34The denial was due to inaccurate billing codes. While we do not believe the Champa enroll will be charged for the ambulance ride, the denial letter listed three appellet structures. None of them the clinical appeal option listed on the Champ VA website. None of them offered an option for a third-party review, something that was considered routine in today's world to denied insurance claims. as they did in the Senate Veterans Affairs Committee on May 21st, 2025. VA has argued in the past that CHAMP is not an insurance product. It's a medical service. I remain steadfast.
▶ 1:00:01The industry, the federal government, and more often than not, VA itself treats CHAMP as an insurance product. If we choose to shop for insurance through healthcare marketplace, Champles are not eligible for financial assistance nor advanced premium tax credits. Every year, Champles receive a 1095b, attesting to the fact that Champa accounts for minimal essential coverage under the Affordable Care Act. Finally, even VA states that Champ is only available to caregivers in the VA's program for comprehensive assistance to family caregivers when they have no other health insurance.
▶ 1:00:31Thus, Champa identifies itself as an insurance plan when it offers proof of coverage and bars use of its plans in the face of other coverage. Indeed, the stance that Champa is not an insurance product is detrimental to v veterans families. At code of support, I recently walked a disabled veteran through enrollment for his wife into Champ VA. Prior to reaching out to us, the veteran had purchased insurance for his dependent, causing a financial burden through the healthcare marketplace, not understanding that Champa provided ACA compliant coverage. In short, Champa remains a complicated mess for users.
▶ 1:01:00While VA has announced positive steps at easing some of these known problems, Champa fixes are far from complete. Champa users need statutory change and cl regulatory clarity. mandated electronic claims filings and claims and clarity in claims appeals processes including a third-party review in VA's mission to fulfill President's Lincoln promise to care for those who have served for our nation's military and for their families caregivers and survivor survivors. Champa is failing as a community.
▶ 1:01:29We cannot continue to allow this egregious lapse of coverage for those who need it most. I thank you for your time and I look forward to your
▶ 1:01:37Thank you, m uh Mrs. Benson. I now recognize Mr. Zer for his uh opening testimony for 5 minutes.
▶ 1:01:46Chairwoman Miller Meeks and Ranking Member Brownley, distinguished members of the committee, thank you for your opportunity. Thank you for the opportunity to appear before you today on behalf of the National Association of County Veteran Service Officers. NACVSO or NACVSO represents the government employed accredited advocates who help veterans and their families access the benefits that they have earned. First, I want to express our sincere appreciation to the ChantV VA staff for their extraordinary progress in reducing the application backlog.
▶ 1:02:13We are hearing reports of applications being processed on average of 10 days and in some as few as four. That is not simply an administrative improvement. It is timely access to health care for eligible dependents and we thank the teams responsible for this achievement. Today I want to highlight several practical refinements that would increase accessibility and efficiency for ChantVA families and the GVSOs who serve them. Our first recommendation is modernizing the ChantVa application process.
▶ 1:02:42Right now GVSOs cannot submit ChantVa applications electronically. Um they must print, complete and then fax or mail them which prevents confirmation of receipt, prevents tracking and makes it difficult to provide updates to Meanwhile, many dependents cannot use A digital submission workflow similar to the Veterans Benefits Administration's national work queue would allow electronic submission, real-time status updates, and reduce burden on CHAMPV VA
▶ 1:03:13Additionally, expanding the VA form 2122 authority to include VHA and ChantVa would allow accredited officers to communicate with CHAVA staff directly, speeding resolution of issues for families. Our second recommendation is expanding provider awareness and Across the country, many community providers do not know what ChantVa is, who it covers, and how the billing works. Some confuse it with Triricare or VA community care, and this creates avoidable access barriers.
▶ 1:03:44Targeted education campaigns, provider toolkits, inclusion, and electronic billing systems, and partnerships with medical associations would meaningfully expand access for spouses, dependents, and caregivers. Third, we recommend redesigning ChantV VA identification cards. Providers frequently mistake the ChantV VA card for the community care card and in some cases dependent have been turned away. A distinct and easily recognizable card would reduce confusion improve the and improve the care experience.
▶ 1:04:13Finally, we urge the committee to address the coverage gap for dependent students turning 18. Under current policy, Champ VA eligibility elapses until school enrollment is verified, a process that often takes 8 to nine months. During this time, dependents incur medical costs out of pocket, claims are lost or forgotten, and families face unnecessary stress despite the fact that VBA has already determined the underlying eligibility.
▶ 1:04:38Provisional continued coverage, automated verification with schools, online certification at va.gov, gov and pre-verification notices would significantly reduce this burden. ChantVa is a very strong program and recent progress demonstrates VA commitment to families of those who have But continued refinement is both necessary and achievable.
▶ 1:05:00Government veteran service officers stand ready to assist VA and this committee in improving processes, expanding access, and ensuring that eligible family members receive timely, reliable health coverage. Thank you for your leadership and thank you for the opportunity to testify today. I'm happy to answer any questions. Thank you.
▶ 1:05:21Thank you very much, uh, Mr. Zenner. Um, as is my typical practice, I'll reserve my, uh, time until all other members have had a chance to ask their questions. I now recognize Ranking Member Brownley for five minutes for any questions she may have.
▶ 1:05:34Thank you, Madam Chair. U, my first question is to Miss Lorenta. Um, thank you for being here. Um, we know based on Miss Benson's testimony that even despite VA's uh recent elimination of the application backlog, and that's a good first step. I want to acknowledge that. That's a good first step. But many families are still waiting to know the status of their applications or their school enrollment certifications.
▶ 1:06:04And the only way for them, the way I understand it, it is to check their status is to call the call center, the Champ VA call center. So, do you know what the average time wait time is to talk to someone on the other end of the call center?
▶ 1:06:21Yes, ma'am. Thank you. It can vary based on the time of day, the day of week. Um, in some cases, it could be as little as 5 to 10 minutes. In other cases, it could be as long as several hours. That
▶ 1:06:35along as long as how many?
▶ 1:06:37Several hours.
▶ 1:06:38Several hours.
▶ 1:06:39Yes, we do have a a call back feature um that is part of the call center, but um it's it's it's not acceptable. Well, I I know my the committee staff called uh the service line four times and all four times uh there was a message saying that the wait time would be over two hours. Not two hours but over two hours.
▶ 1:07:05So why I mean that seems like an easy problem to solve and I don't know why it's not being solved. I mean it is great to to to you know attack the backlog. that's great. But if people can't get finality to the situation, that's not great. And this is, you know, waiting more than two hours for folks can be um pretty
▶ 1:07:34Yes, ma'am. I I I agree with you. We are taking a series of steps um in order to address the issue and I wish that it was an easy problem to solve because please be assured if it was it would have been solved. Um some of the various steps that we are in the process of taking are looking at our workflows um standardizing some of the workflows. We've also begun leveraging additional contractor support.
▶ 1:08:03We do have a a contractor with whom we work that um assists in surging and um answering the call center. A very important step that we are working on uh conducting is being able to do online status um verification so that there would not even be a need for a phone call. The the veteran andor the beneficiary would be able to check online and be able to see the status of their application, the status of their claim.
▶ 1:08:33Um but that that's and we are planning to be able to do that in 2026. Um efforts are underway. Um these are some of the steps that that we're
▶ 1:08:43Okay. Until that program happens, if somebody is waiting over two hours to talk to a live human being, they're uh their issue has not been resolved. Then do they just say thank have to say thank you very much and try next week and do go through the same exercise or do you prioritize that person and call them back with a resolution to what the issue is so that they don't have to continually go through this horrendous
▶ 1:09:13Yes, that is one of the features that are part of our call centers. We are able to call the veteran andor the beneficiary back.
▶ 1:09:22Okay. U Miss Benson. So, uh, again, thank you for being here. You've been quite helpful to us, um, uh, looking into this process. So, really appreciate your your time and focus on this. Uh, in your testimony, you discussed how difficult it's been to find pediatricians and mental health care providers willing to accept the CHAMP uh, VA payment.
▶ 1:09:45So I and I know you talked about, you know, having um a list of a network of providers, you know, that you can reference somehow. Um I don't think that that's going to happen overnight. Um we're still arguing with the VA whether this is an insurance policy or or not. Um but what are your suggestions? Um what do you think VA could do to encourage more providers uh in into this program?
▶ 1:10:14Um, thank you for the question and thank you for having me here again. Um, I think one of the first things that we need is provider education. Providers don't know they have to enroll in the EFT system. Providers don't know that it runs on a Medicare and Medicaid background or backbone versus a Triricare backbone. Um, I've had to actually walk urgent carers through how to file and what system to file it on. That knowledge is going to be key in getting to providers to come on board.
▶ 1:10:42What will also be key is providers knowing how much they're going to get paid. Um, it's fine that there's an acceptable rate. Most providers I talk to know that it is somewhere in within the CMS rates, but that it vaccates for me. And I am a lay person, but looking back at it going, it's out of IVC. There is a CCN. There are already contracts available. It's mind-boggling to me that we can't use a backbone that's already there.
▶ 1:11:09Thank you. Uh, my time is up. if I yield
▶ 1:11:12Uh, thank you, Ranking Member Brownley. I now recognize Representative uh King Hines for uh five minutes for any questions she may have.
▶ 1:11:19Thank you, Chairwoman and Ranking Member Brownley. Um, before I begin, I want to say thank you to Secretary Collins and the VA team for making good on the promise to cut down the significant backlog of veteran veteran claims. That progress matters uh not just in numbers, but in real lives, in real families, and in the trust veterans place in the organization. It shows what's possible when the VA focuses on outcomes instead of obstacles.
▶ 1:11:45I am also very encouraged that you're finally moving to modernize uh ChantVa through the provider directory for families especially in the territories. I'm from the CNI, that's the district that I represent. Simply knowing which providers are available, which ones accept Champva and where they can turn to uh for care is very critical. So, it's long overdue and it's a positive step and I want to give a big ups and kudos to all of you.
▶ 1:12:10But even with with these improvements, the challenges remains very serious for my district. The GAO has been very clear. Veterans and their families um in the CNMI and across the territories face some of the highest barriers to healthcare access anywhere in the United States.
▶ 1:12:27and some uh and those same structural g structural gaps, too few providers, limited specialty care, long-distance travel, and ver virtually no territory specific data directly affects the families who rely on Champa.
▶ 1:12:47So for us right on paper, Champa is uh Champva is available everywhere where the flag flies, but in places like the Cinema or Guam, access can still feel more theoretical than than real. And I I don't think that we can fix this issue if we can't um if we don't know what to measure and we can't Congress can't hold the VA accountable without the data.
▶ 1:13:17So today I I hope that we can have a conversation about the gaps in in data, right? So that these benefits on statute uh actually truly works for everyone no matter which zip code you live at.
▶ 1:13:33And so my question then is um is um how how can the VA assure Congress that this program is functioning equitably if it does not track utilization access weight times or outcomes for territories because I looked I scoured the internet I scoured the GAO reports IG reports and I don't see any data with regards to this type of program for the terri territories.
▶ 1:14:06Yes, thank you very much for that question. Um, and you're right, to the best of my knowledge, we're we're not tracking um weight times. We are not tracking um specific outcomes um for the beneficiaries that are in the program. We are able to look based on claims how many claims are coming from what area.
▶ 1:14:28Um, we have I I I don't know the specific data and we're happy to take it for the record to find out, you know, by territory the the number of at least claims that have been paid. Um, that gives us a sense of the um the services that are being offered in that area.
▶ 1:14:48I think that that's one of the reasons why we have come to appreciate um that a provider directory is a very first step but is a first step so that we can begin to even assess the adequacy of the existing providers that we have. It will also help us to um provide more targeted outreach so that if um for example to Mrs.
▶ 1:15:11Benson's point, we see that there's an area that lacks a pediatrician that is a Champ VA provider, we will specifically reach out to all of the pediatricians in that geographic area and try to work with them. Um maybe work with a professional organization, for example, to encourage their participation in in Champ VA. It's just an example of what we've been discussing internally as mechanisms to be able to address some of these problems.
▶ 1:15:38Thank you. I appreciate that. And you know I do have some um some data here with regards to uh fiscal year 2023. Uh what we're seeing in the CNMI is that we have 45 enroles.
▶ 1:15:54we only have 15 users at a utilization rate of 33.3% which is a drastic there's a significant uh difference with regards to how the trends are um across the United States in comparison to to this utilization number and I just kind of wanted to get a better understanding of why you think that is and how we can make some reforms to be able to get more people to be one aware of the program to know
▶ 1:16:24which care providers that they can go go to so that they can have access to some of this care and uh you know have the data to be able to justify uh whatever infrastructure that that need that is needed to be put into place in the territories.
▶ 1:16:40Yes ma'am. What I'd like to be able to do is first obtain the more recent data from FY2025. Um the data that you cited is is in keeping with what we have seen that is overall we have about 67% utilization of chant VA services um within our total group of enroles. Um so I would like to see if there's been any difference between the 23 numbers that you cited and the 25 um currently.
▶ 1:17:09Um, and then you're right, we need to dig into it and try to have a better understanding of why there are differences, if in fact we find differences.
▶ 1:17:18Okay, thank you. I'm out of time. Thank
▶ 1:17:22Thank you very much. The chair now recognizes Representative Sheris McCormack for five minutes for any questions she may have.
▶ 1:17:28Thank you, Madam Chair, and thank you also ranking member for holding this important um hearing. Um, you know, serving our veterans and especially their families is one of our primary responsibilities and promises. So, I'm happy that we're looking at Champ VA, especially since it serves over 700,000 people in Florida. We're looking around my district, 60,000. And we've had several questions to the families who are using Champ VA.
▶ 1:17:53While Champier is imperfect, it provides a lifeline to so many families, and it must continue to be bolstered and strengthened to adequately serve those who need it the most. Over the past few years, I've heard from veterans and their families about their exposure to environmental toxins while living near the military installations. Whether it's Red Hill or Camp Leune, we've seen the devastating effects of toxic exposure on families like cancer, infertility, and neurodeivergent diseases.
▶ 1:18:21This is of concern for military families, and no military family should be left behind to fend for themselves. Dr. Lorent, has your department looked at expanding the scope of CHAMP VA to include military families who have been exposed to um Um at this point in time, the eligibility criteria um are in statute and we um include or deem that a family member is eligible based on
▶ 1:18:51those existing criteria within the veterans and family member program. We do have certain um um outcomes related additional programs such as the spinoipida program. Um we have the smaller Vietnam veteran women's whose children have certain disabilities. Um and then we also have the campleume family member program. Each of those is designed for very specific situations, very specific toxic exposures.
▶ 1:19:21Um and so those those are the programs that we currently have. And do you think there could be other avenues to provide coverage or do you think that um Champ VA can solely handle it?
▶ 1:19:33Well, because I've described some very very specific areas um it they only covered those areas. We're we're more than happy to work with Congress in order to explore any other areas that you know could be um assessed and reviewed in the future. I guess my question also is because we're thinking about how many people are actually being exposed. Are there other departments or other areas that we should look into in addition to champVA?
▶ 1:20:01I don't know if you would know that
▶ 1:20:02I I I was just about to say um I I don't think that um I'm necessarily prepared to address that question today, but more than happy to take it for the record and reach out to some of our other program offices that I think are better suited to be able to address that question.
▶ 1:20:18Thank you. Um, while I'm optimistic about the future of Champier, I understand that the current program is not without its issues. Miss Benson, I was deeply disturbed to hear that you had to put over $110,000 promisary note in Champier um, refused to cover a medically necessary hospitalization. This is definitely unacceptable. No person, especially the spouse of a veteran who has served our country, should ever have to put a down payment just to see a doctor. Dr. Lorraine.
▶ 1:20:47Um, how typical is this required for people to put down a down
▶ 1:20:52Congresswoman, I I have to be frank with you. I I've not ever encountered this type of a situation before. Um, and I would like to separately reach out to Miss Benson to have a little more detail about the specific circumstances. um not only to be able to address this specific issue, but to have a sense of are there gaps that we're not addressing so that we can figure out what are the steps that need to be taken so it doesn't happen to other people.
▶ 1:21:22So is this the first time you're hearing of this kind of situation?
▶ 1:21:24It's the first time I'm hearing of it. Yes, ma'am.
▶ 1:21:27Okay. And how would you feel if we had any kind of agreement or arrangement to actually track these situations and other outliers just so we can make sure that this isn't happening and that there are other um obstacles to actually I I I would very much appreciate any similar types of situations or any other kinds of cases like this specifically because it's our duty as as um we've discussed it is our duty not only to take care of the veterans veterans
▶ 1:21:57and their families and caregivers, but to fix problems that need to be fixed.
▶ 1:22:03Thank you so much. I yield back.
▶ 1:22:05Uh, thank you. The chair now recognizes Dr. Dexter for five minutes for any questions she may have.
▶ 1:22:10Thank you very much to Chairwoman Miller Meeks and to Ranking Member Brownley for again having this very important hearing and thank you to our witnesses for coming to testify today. According to data from the veteran health veterans health administrators office of integrated veteran care there are over 10,000 Oregonians um enrolled in champa and to those Oregonians we have made a solemn promise as we have been discussing that in return for the immense sacrifices their family members have made we will ensure
▶ 1:22:40they get access to health care services they need however as Miss Benson has shared in her testimony we continue to fall short on delivering on that promise promise. When a family member who is owed a care through the VA is sick, the last thing in the world that they should be doing is fighting through red tape to be seen, and they most certainly should not be signing promisary notes, agreeing to pay hundreds of thousands of dollars for care in case the VA payment falls through.
▶ 1:23:07So, as the number of Champ VA beneficiaries continue to grow with PACET Act implementation and if more families are forced to turn to this coverage because Congress is unable to implement a fix to the ACA premium tax credit enhancement being taken away, we must be focused on getting this system to work better for families. Dr. Delorent Dellore, sorry.
▶ 1:23:30Um, in your testimony, I was pleased to see discussion of the need to address the der of information about where champa beneficiaries can seek care. As I understand it, under the current system, beneficiaries have to individual individually to contact providers and and we have discussed that. It's obviously frustrating and it needs updating. It strikes me that one solution to the der of option available to Champ VA beneficiaries would be to require community care network providers to accept Champ VA payments.
▶ 1:24:00This would also have the benefit of meaning VA would only have to maintain a single provider directory. Can you comment on any statutory or regulatory hurdles that would need to be overcome to consider this as an option?
▶ 1:24:13I appreciate that question. Um I don't know the answer to that question. Um let me check for a moment with Mr. Finel to see if you know he has um some recognition or knowledge to be able to
▶ 1:24:29I think it it's an unfair thing to ask on the fly for you to put testimony before a congressional hearing. So I'll just ask um that we do and and we ask for many questions to be responded to and often we don't get them. If I can just assure myself that you will get back to me, that's totally appropriate. Thank you.
▶ 1:24:47Um, as this committee continues to discuss and conduct necessary oversight of this program, Dr. Delorente, can you uh share the date on which the number of backlogged applications peaked and the number of pending applications on that date like the high point when we had the worst backlog?
▶ 1:25:07Yes, ma'am. It was approximately in May of this year 2025.
▶ 1:25:11Okay. Thank you. And can you share the percentage of applications that were approved versus denied in 2025 as a compared to the same period in the prior fiscal year?
▶ 1:25:22I don't know the percent approved in I do know that in FY25 approximately 80% of the applications are approved.
▶ 1:25:32Okay. Thank you. And I have heard that VA to clear this backlog. They have set up a separate key for Q sorry for beneficiaries that have another form of insurance with an unreported backlog. Um how many applications are in this queue awaiting a determination from VA?
▶ 1:25:51I'm going to ask Mr. Fenel to address that question. Um if you don't mind.
▶ 1:25:57Yeah please. Mr. Fenel.
▶ 1:25:58Yes. Thank you for the question. And currently we are now processing and have the ability to process OHI with the application. So that that's a um a process improvement that we've included in order to expedite both of the of the processing of OI other health insurance and the CHVA application.
▶ 1:26:18Um right now we are applying automation to those OI documents that are separate and we are able to uh automate the processing of a grand majority of those and so we had a height of around 300,000 when we initiated the queue that you referenced and I think now we are in real time meaning we were processing those as quickly as we are the applications themselves and I want to say we might have around 20,000 remaining
▶ 1:26:48to process but again in in applying those process and automated solutions that is real time meaning over the next week those will be processed
▶ 1:26:57and if I may to follow up on that so 300,000 almost immediately I'm assuming these automated tools are a fora
▶ 1:27:06there are and so um the the quality control measures are the business rules that are upfront that we apply and some of that may not necessarily be AI as much as just a business rule that follows statutory and regulatory
▶ 1:27:21Okay. Thank you. I have over time yield.
▶ 1:27:24Thank you very much. The chair now recognizes Dr. Conaway for five minutes for any questions you may have.
▶ 1:27:29Uh thank you chairwoman Miller Meeks and Ranking Member Brownley for putting this hearing together so that we can conduct a muchneeded oversight on this very important program. As of November 2025, Champ VA is providing healthc care coverage to more than 1 million At the time at a time when health care prices are increasing and the uh expiration of the Affordable Care Act is looming, we must strengthen this health care program for independents and survivors
▶ 1:27:59of veterans. In my state of New Jersey, premiums are protected to increase by 174%. The average annual premium cost could jump almost $2,800 on average. uh and for some it could uh mean that um costs are will go up by tens of thousands.
▶ 1:28:18This is unacceptable and I encourage uh my colleagues uh to find a solution to this looming um cliff that so many Americans are facing will face with respect to their healthcare if a solution is not found uh to the um to the problem of the expiration of the premium tax credits.
▶ 1:28:40Uh, I'm curious to know, Miss uh, Laurent, uh, do you anticipate the expiration that the expiration of the ACA tax credits will impact enrollment for CHM VA?
▶ 1:28:52Thank you very much. I appreciate that question. Um, and I truly don't know the the answer. Um, we still would need the veteran sponsor to meet the eligibility criteria. Um and so that becomes, you know, sort of the the first um thing that has to um occur.
▶ 1:29:12Um but I I I simply don't know how many um spouses or dependents of veterans that are 100% service connected, permanent in total are currently receiving ACA benefits.
▶ 1:29:25Are you conducting any planning and um anticipation of the some 20 million people who are going to lose these tax credits? Are you doing any anticipatory planning to prepare for a potential influx of u of new um applications uh as um the um people can no longer afford uh their health insurance benefit or health insurance under the ACA?
▶ 1:29:54Our primary planning um and we do work very closely with projections and enrollment and as well as with VHA fiscal um has been looking at the increasing numbers year-over-year of beneficiaries who've been enrolling in Champ VA for many years. Um that figure was pretty steady about 5 to 8% year-over-year growth.
▶ 1:30:17um then pact was enacted that growth went to about 13 to 14% and during the past year we've seen um almost a 22 to 23% increase. Um that in and of itself we are and have been tracking very very closely.
▶ 1:30:34We are engaging in projections so that we assure that we have sufficient budget um currently and in future years to address the health care needs based on past expenditures with adjustments for those increases. Um have we factored in impact from ACA specifically? No sir, at this point we have not.
▶ 1:30:55And just um do you know then how many uh of your enrolles also have uh insurance under the ACA? Do you have that number?
▶ 1:31:05I do not. Um, let me check with Mr. Fitnel. Do you know?
▶ 1:31:10Thank you, sir, for the question. I I do not know the answer to that question. Um, I but I I am apprised of the eligibility criteria and I I don't see a situation where that changes with the ACA tax credit, which is permanently and totally disabled.
▶ 1:31:27Just reclaim my time because I'm running out. Oh, sorry. So you don't have now I just want to get to this question of of the lack of providers in in particular markets uh and and what's being done about that. Now typically I mean as one who ran a practice years ago um you know you you sort of have to determine um when you determine to bring on an insurance policy how much does it pay? Is it is it worth my time compared to the other um uh insuranceances that I accept um covering you know people who can come to the office.
▶ 1:31:57So, um, is one problem that the that Champ VA is not paying enough and two, um, that it's perhaps too difficult for people to enroll in Champ VA? If have you looked into that and and how are you addressing those those factors which I'm sure are impacting the number of physicians who are accepting Champier uh, patients.
▶ 1:32:20Yes, sir. Thank you. And happy to answer that question. we we are required by law to um to pay like or similar to triricare. So that's actually those are the payment methodologies that are loaded into our system our triricare methodologies. The other the other aspect to this is we are normally a secondary payer benefit. So um if they have Medicare or they have other health insurance that's going to be build first and I would imagine that would be a primary concern to to the treating physician.
▶ 1:32:49Um, but if it does get to a secondary payment, we would pay like or similar to Triricare.
▶ 1:32:58Thank you very much, Dr. Conway. I now recognize myself for five minutes. Uh, if I can, I'm just going to have a point of clarification. Um, certainly myself uh and uh members uh of my party and members of this committee want to make sure that health care costs are brought down for everyone, not just a select few that may be on enhanced premium tax credits. and the premium tax credits under the ACA are not expiring. Only the enhanced premium tax credits are expiring.
▶ 1:33:25So, I thought I would put forth that clarification since this is entered into the record. Additionally, we don't force providers to accept Medicaid. We don't force providers to accept Triricare. uh and being a provider and a veteran, it seems to me that provor forcing providers to accept chant VA who are in the community, would that be considered um indentured servitude? So, I will pose that question to Dr. Lorente and you can uh submit an answer in writing.
▶ 1:33:54Uh so, uh thank you for that. Just making those points valid that we look at the constitutional nature of what it is that we may require of someone to do. Um Dr. um what's the indust ind industry standard for the amount of time to process claims both paper and electronic and then how does the VA compare if you have that information
▶ 1:34:15thank you um chairwoman I don't know uh the answer to that question but happy to take it for the record um and then provide the comparative numbers
▶ 1:34:26and then um I applaud the efforts at uh getting through the backlog and applying applying more techn technology to uh improving backlog and also uh your efforts in trying to uh keep family members and providers up to date on the status of their claims. And um to that end, is the VA using artificial intelligence or augmented intelligence to improve both applications, the claims process or status and updates for that?
▶ 1:34:55And and if so, how and if not, why?
▶ 1:34:59Thank you very much for that question. I'm going to ask Mr. Finel to address that because he's was way more technical savvy than I do.
▶ 1:35:08Thank you for the opportunity to answer that question. And it it began as as I answered before with just with business rules and loading those into the system to make automated decisions when it comes to artificial intelligence which brings in an additional capability. We are starting to apply some of those uh capabilities when it comes to these uh newer modernized platforms that we are moving into for processing both claims and eligibility applications.
▶ 1:35:40And Miss Benson, I think that you've answered this question in your testimony, but I just want to reiterate it. Would it help to have a provider directory for families and caregivers? Uh, and if so, are you supportive of uh, Representative Kigan's legislation?
▶ 1:35:56Uh, thank you for the question. Um, I'm not familiar with the legislation, but I can say it would be helpful to have both a contracted network and a provider directory. Yes, thank you.
▶ 1:36:06Great. Thank you. Um, I yield back. I want to thank all our witnesses for being here. I'm going to recognize Miss Brownley for any closing remarks you may have. Oh. Oh, I'm my apologies. We have another member snuck in. Uh the chair now recognizes uh Representative Kiggins for five minutes for any testimony she may have.
▶ 1:36:24Thank you, Madam Chair, for having me here today to discuss the civilian health and medical program of the Department of Veteran Veteran Affairs or CHAMP VA and to highlight how Congress can improve this program for our veteran caregivers and dependents. I represent Hampton Roads, Virginia, which is home to thousands of veteran families who use the Champ VA system to support our nation's veterans and to access their veteran healthcare. Caregiving requires tremendous sacrifice, but access to quality health care shouldn't be one of them.
▶ 1:36:52JP VA is a vital program for the caregivers and dependence of permanently disabled veterans. It ensures they can continue to support the veteran in their lives and still receive the health care services they require. However, it can be difficult for caregivers and dependents to find providers in their community that accept Champ VA. On most occasions, caregivers have to do their own research and find specific providers that will take their coverage.
▶ 1:37:16To rectify the sit situation, I introduced the Clarity on Care Options Act, which directs the VA's community care network to create a public-f facing list of all providers who were a network for VA enrolles. We must make this provider information accessible to caregivers and dependents of disabled veterans. The easier we make finding health care for our caregivers, the more time they can spend with their loved ones.
▶ 1:37:39I want to thank our witnesses for thank taking the time to educate us about the gaps we see in this program and what we can do to help increase support to those who support our men and women who served our country. With that, I have a another few questions uh for our witnesses if there's time. When it comes to finding providers that accept Champ VA, how is your experience? And this is for um Miss Benson. How has your experience been? Is there any difficulty locating specialty healthcare providers who accept Champ VA?
▶ 1:38:09Uh thank you for the question. Yes, there's a terrible issue. Um back to the hospitalization I mentioned, I had a daughter who needed specialty care. I called 26 hospitals across the nation only one would take. Uh even today I pay out of pocket. Uh no mental health care provider and I am in Florida uh between very two large droplesses uh accepts champ for teens.
▶ 1:38:33Um even for myself um if it is not hospitalization which is mandated to file um only one major network takes it. Um so we end up paying most of our care out of pocket above and beyond Champa and cash.
▶ 1:38:50Thank you. And Mr. Zenner, from your perspective, what barriers do you often see beneficiaries of Champ VA face when it comes to accessing their benefits?
▶ 1:39:01Yes, thank you for the question. um very similar um lack of education of providers, confusion um with the ChantV VA card itself um are two of the biggest barriers that we currently see as county veteran service officers.
▶ 1:39:16So would a directory or a list of providers of sorts be beneficial then?
▶ 1:39:21in these cases for sure. And then for Dr. Lorente, many caregivers report learning about Champ VA only years after becoming eligible in most cases as the program is currently. How do veteran dependents find out about Champ VA?
▶ 1:39:36Yes, thank you very much for that question. So, there are a couple of different ways. One is that um part of the changes that have occurred in VBA when the veteran becomes permanent in total 100% part of the packet that they receive describing the rating includes information about Champ VA for their dependence um and how to enroll in the program.
▶ 1:39:59The second way is the Champ VA program itself does do direct outreach to potentially eligible beneficiaries advising them of um the the program and um how to apply for it. Um we are continuing to also engage in additional outreach efforts um because one of the things that we've discussed internally is that we could certainly be doing a better job um of of promoting um this this benefit
▶ 1:40:30and specifically how is the VA improving the CHP VA's phone and customer service operations given reports of long wait times and inconsistent information.
▶ 1:40:39So we've engaged in a a series of steps towards that. One is we have increased um contractor support um that can be specifically surged during peak times. Um in addition to that we are working on implementing some new telefan systems so that it will begin to um offer more in the way of selfservice so that those issues that can be addressed via self-service are addressed and then it moves the those clients those persons
▶ 1:41:09that need um agent assisted um calls. Um it sort of you know separates out the ones that can be handled by a self-service. Um, in addition to that, we're looking at our workflows. Um, streamlining some of those, um, being able to standardize some of the workflows as well. Um, because there are things that we've identified that are being done, you know, with too much variance. Um, and that's also then leading to some of the delays. Um, just a few examples.
▶ 1:41:38Yeah, great. Thank you for working on that. And last question, has the VA can Oh, I'm sorry. Maybe I'll save it for later. Thank you. I yield back
▶ 1:41:46just to know that I'm fair to everyone in the uh hearing room. Thank you. Your time has uh expired. Uh the gentleoman yields back. I now recognize ranking member Brownley for any closing statements you may have.
▶ 1:41:57Well, um I would just say, Madam Chair, I thank you for um uh having this hearing. I think it is we need to get the VA back to briefing staff so we can keep updating on, you know, what progress is being made. That's that's the frustration. We don't have a plan in front of us. We don't have a timeline in front of us. So, there's no way for us to do the oversight that we really need to do. This is an important program um that we need to get right.
▶ 1:42:26And I think we're all clear on where the problems lie um and what needs to be done. And it's just it's a matter of doing it. Um, and if the secretary was willing to hire more people or give people more overtime uh to deal with the backlog, we need to do the same to all these other problematic areas to get them, you know, up to speed and running.
▶ 1:42:51So I honestly believe that if we accept the fact that Champ VA is is more like an insurance plan than a medical care benefit, you will you will see directly what needs to be done and how to do it if you just follow the model of what insurance plans do in including a directory of providers, whatever.
▶ 1:43:17But, um, you know, we need we need to have the oversight and I hope I hope we can have another hearing to do our due diligence um, as we move forward. But, um, I thank you all for being here. And, Miss Benson, thank you for being here. Thank you for all the help that you do um, for so many other veterans who need your help, veterans, their families, and caregivers who need your help and support. I yield.
▶ 1:43:43Well, certainly it is an important hearing. Um I appreciate Dr. Rente what you and the office has done to improve the backlog. Uh and then your continued work on uh keeping family members and caregivers uh trying to improve the um knowledge of where their claims are. Uh and then the other uh efforts that we need to take on provider education as Miss Benson and Mr.
▶ 1:44:06presenter had said uh how to file claims uh and how much they're paid so that we can get providers into this very important program to make sure that both uh family members, spouses, and caregivers are aware and have access to the benefits that uh those veterans have earned for them. Um I'd like to take uh this time to thank everyone for their participation. Thank you so much for your patience and I do apologize.
▶ 1:44:31Although it was out of my hands, I still feel it's necessary to apologize for the inconvenience to you all and to those who wanted to participate in today's hearing. Um, and I appreciate the discussions we've had on this important topic, and we will continue to have uh uh oversight. The complete written statement of today's witnesses will be entered into the hearing record. I ask unanimous consent that all members have five legislative days to revise and extend their remarks and include extraneous material. Hearing no objections, so ordered.
▶ 1:44:59I thank the members and the witnesses for their attendance and participation today. This hearing is now adjourned.