Bill Would Align Age Eligibility for CHAMPVA with Tricare, Affordable Care Act

Kyle, 2, hangs out with Dad while eating a cookie during the Military Child Education Coalition's Tell Me a Story event at the Wounded Warrior Battalion's Warrior Hope and Care Center at Camp Pendleton April 30 (Sarah Wolff-Diaz, U.S. Marines)
Kyle, 2, hangs out with Dad while eating a cookie during the Military Child Education Coalition's Tell Me a Story event at the Wounded Warrior Battalion's Warrior Hope and Care Center at Camp Pendleton April 30 (Sarah Wolff-Diaz, U.S. Marines)

For the sixth straight Congress -- since the Affordable Care Act (ACA) passed in 2010 -- lawmakers are trying again to increase eligibility for Civilian Health and Medical Program of the Department of Veterans Affairs, or CHAMPVA, to age 26.

The move would align CHAMPVA, the program that provides private sector health coverage for the spouses and children of 100% disabled veterans among others, with requirements of the ACA as well as Tricare eligibility.

Chairwoman of the House Veterans Affairs health subcommittee Rep. Julia Brownley, D-California, and Sen. Sherrod Brown, D-Ohio, have introduced legislation that would increase eligibility to age 26 for eligible adult children, regardless of marital status.

Brownley called the increase a "moral imperative."

"One of the most popular and widely known benefits of the Affordable Care Act is allowing kids to stay on their parent's health insurance until age 26, and it is absolutely unacceptable that children of those who have sacrificed the most for our country do not have the same protections afforded to other families," Brownley said.

CHAMPVA beneficiaries usually pay 25% of the cost of their medical care, up to an annual catastrophic cap of $3,000, plus an annual outpatient deductible of $50 per individual or $100 per family.

CHAMPVA pays the remaining 75% of the cost of the beneficiaries' medical care and is usually a secondary payer to other health insurance coverage and Medicare.

Children of qualifying veterans are eligible until age 18, or age 23 if they are enrolled in school full-time.

The ACA required private insurance companies that offer dependent child coverage to provide it to adult children under a parent's plan until age 26.

But when the ACA was negotiated, Tricare and CHAMPVA purposefully were excluded from the act's requirements, leaving children of active-duty personnel and military retirees, as well as those eligible for CHAMPVA, unable to remain on their parents' insurance past age 23.

In 2010, Congress extended coverage to age 26 for dependents enrolled in Tricare, but with a catch: the new program needed to cover its own cost, and thus, beneficiaries enrolled in Tricare Young Adult Prime or Tricare Young Adult Select pay monthly premiums.

Currently most beneficiaries on Tricare Young Adult Prime pay $358 per month. Those on Tricare Young Adult Select pay $214 each month.

Brownley's and Brown's bills contain no provisions for offsetting the cost of extending CHAMPVA coverage for beneficiaries ages 23 to 26.

According to the Congressional Research Service, roughly 479,000 people were enrolled in CHAMPVA in fiscal 2017, with 361,000 actually using the benefit at least once during the year.

The number of spouses and children using CHAMPVA has risen 485% since fiscal 2001, up from 61,900. CRS attributes the growth to the increase in eligible dependents of Vietnam-era veterans who have experienced a worsening of symptoms and change in disability status.

The Military Coalition, a group of military support and veterans service organizations that represents 5.5 million active duty personnel, family members and veterans, sent a letter April 4 to Brownley and Brown strongly endorsing their bills. The group called the legislation "long overdue."

"It is time to pass this important piece of legislation," the advocates wrote. "Your sponsorship ... gives veterans and their children a great deal of encouragement that they have not been forgotten."

-- Patricia Kime can be reached at Patricia.Kime@Military.com. Follow her on Twitter at @patriciakime.

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