States can reduce Medicaid spending if the beneficiaries are also veterans, explains a veteran who started outreach in Washington state, which has since saved over $100 million since 2002.
Bill Allman’s first inkling that something was wrong was when he was processing cost of living allowance updates from the federal government; a supervisor of long-term care for Washington state’s human services department, Allman was managing clients in long-term care using Medicaid funds in Clark County, and noticed some numbers were off.
As he looked at the numbers that clients should be receiving, he noticed something else. The number of veterans that Clark County should be serving was lower than he expected. A Vietnam veteran himself, he saw that the state overall had a higher percentage, but his county was 2% lower, which he thought was curious, given the demographic makeup of the county.
Then, an elderly widow of a veteran came to see him with a $75,000 repayment notice from Medicaid, he said.
What followed next led to the creation of a first-of-its-kind program in the country called the Veterans Benefit Enhancement Program (VBEP), and before Allman retires at the end of the year, he wants more states to know about it.
Under Medicaid repayment state recovery rules for long-term care, the government is allowed to recoup the costs of care from a family's estate—in most cases, typically, from the sale of a house. The woman thought that maybe her husband had something in his military benefits that would help with the bill. She wasn’t familar with the details, but recalled that her spouse, a retired US Navy Commander, had medical coverage at one point.
By contacting a different department—state veteran affairs—Allman discovered that the man was using Medicaid when he also could have been using veterans benefits to pay for his long-term care, which was necessary after a stroke.
“And it occurred to me right then—it was an epiphany—that I wondered how many other clients that are particularly long-term care—related get bills for a state recovery that we weren't aware of and might have military coverage, or if they don’t already, could qualify for military coverage and not be aware of it. So I brought my idea to the state Department of Veteran Affairs and they were extremely excited and said, ‘you know, you’re onto something.’”
His boss at the time was interested in the idea and told Allman to go to work. In the first year of a pilot program run in Clark County, the state saved $800,000. And the woman he helped was able to save $250 a month by dropping a separate policy for prescription drug coverage (it was 2002 and Part D coverage did not begin until 2006) and moving onto eligible military benefits.
To date, Washington has saved more than $100 million, with $23 million coming from 2019 alone.
To match veterans to benefits, states use the Public Assistance Reporting Information System (PARIS), which is run by HHS. Its original use was to allow officials to make sure that beneficiaries receiving any kind of assistance were not “double dipping” into public funds or engaging in fraud. It contains Social Security numbers and Department of Defense and Veterans Administration files.
By examining and comparing files in PARIS with their own files, states can see if there are veterans who are not receiving benefits or are eligible for additional monthly funds called Aid and Attendance, which pays an additional amount for veterans or spouses who need help with the activities of daily living. Unlike Medicaid, the use of VA funds does not need to be repaid. But few veterans and their families know about the programs. Even television journalist Joan Lunden wrote about the issue 2 years ago, when her mom died before she was able to access the funds.
The program requires an outreach effort; Allman, a Vietnam veteran, will also go though lists looking for veterans that he suspects may be a candidate for Agent Orange disability claims, based on their diagnostic codes. In 2009, the Department of Veterans Affairs added 3 new diseases to the list of diseases that they assume are linked to herbicide agents: hairy cell and other B-cell leukemias, Parkinson disease, and ischemic heart disease.
Allman is retiring at the end of the year and would like remaining states to get on board and create their own VBEP. About 32 states are in various stages of doing what Washington did. Why don’t more states participate? According to a presentation he gave a few years ago, the most commonly cited reasons are bureaucratic, siloed state governments; a lack of leadership; or a lack of understanding for both states and veterans.
But veteran's benefits are underused, he said, and he spends even his off-hours doing outreach to veteran organizations and retired military officier organizations. To Allman, the savings are secondary.