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Community providers warn reduced authorizations, lower fees and Medicaid cuts threaten rural veteran care
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Summary
Community home‑care providers and advocates told legislators that reduced authorization lengths, a lower 2025 fee schedule, and looming Medicaid cuts risk eroding rural provider participation and veterans' access to in‑home and specialty services.
Community providers and a small‑business home health operator told a House Veterans' Affairs subcommittee that recent VA process changes and pending Medicaid reductions are already constraining access for veterans in rural areas.
Amanda Newman, CEO of Western Illinois Home Health Care, said her agency — which serves a 10‑county rural area and contracts with VA community care networks — has seen authorizations reduced from 12 months to six months or less and reductions in non‑bundled fee schedules that she said make travel‑heavy rural work financially unsustainable. "Community care is not an alternative to the VA. It is an extension of it," Newman told the committee while urging fair reimbursement and longer authorization periods.
Nut graf: Providers said three operational changes are constraining care: (1) reduced authorization periods that disrupt continuity for homebound veterans; (2) a 2025 fee schedule that providers say under‑reimburses travel costs for rural work; and (3) delayed or difficult VA payments for community services, which can create collections risk for veterans and payment risk for clinics.
Newman described individual cases: a 79‑year‑old veteran in a rural town denied homemaker services and denied physical therapy, instead being directed to drive 53 miles each way for twice‑weekly appointments; and an 80‑ to 85‑year‑old denied home health aide services because a phone screening indicated the veteran could shave. These examples, Newman said, illustrate how telephone screening and shortened authorization windows can miss activities of daily living that justify in‑home services.
Christina Keenan of the Veterans of Foreign Wars recounted billing problems for community providers — including one mammogram that took six months to be paid and led to collections notices. Keenan said poor record sharing and unclear referral responsibility sometimes place the administrative burden on veterans.
Witnesses also warned that deep federal Medicaid cuts projected in pending legislation could force rural hospitals and long‑term care facilities to close, further shrinking the pool of community providers. Committee members cited a University of North Carolina analysis identifying 338 rural hospitals at risk under the proposed cuts; witnesses said closures would compound access problems in the places community care was intended to help.
Ending: Lawmakers heard requests to restore longer authorization periods, ensure fair travel‑related reimbursement in fee schedules, speed VA payments to community providers, and monitor the impact of Medicaid changes on rural provider networks. No formal changes were adopted during the hearing.
