House Veterans Affairs subcommittee reviews CHAMP VA modernization, remaining provider and claims gaps

Chairwoman Miller Meeks opened a House Veterans Affairs Subcommittee on Health oversight hearing by praising recent steps the Department of Veterans Affairs has taken to modernize the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMP VA) and eliminate application backlogs, and she urged continued oversight to ensure veterans’ families can access benefits more reliably.

The most immediate developments recounted at the hearing were VA assertions that longstanding backlogs have been cleared and that claims processing has sped up. Dr. Maria Laurente, acting Assistant Undersecretary for Health at the VA’s Office of Integrated Veteran Care, told the panel that CHAMP VA serves more than 1 million beneficiaries and receives roughly 4,000 new applications per week. She said recent reforms reduced the historic appeals backlog from more than 20,000 cases to about 1,000 and that more than 90% of medical and pharmacy claims are now processed electronically within days. "Under Secretary Collins’ leadership, the application backlog, previously exceeding 70,000 cases, has been eliminated," Laurente said in her prepared testimony.

Despite those gains, members and witnesses described persistent access and administrative problems that they said continue to harm families. Kara Benson of the Code of Support Foundation, who also testified as a CHAMP VA beneficiary, recounted cases in which providers experienced extreme payment delays and families incurred large out-of-pocket costs. Benson said one family signed a $110,000 promissory note to ensure a needed hospitalization and that some providers waited more than two years for payment. "With one provider waiting over 27 months for payment," Benson said, "CHAMP VA’s appropriate care has felt anything but appropriate."

Committee members pressed VA officials on concrete operational issues. Ranking Member Brownlee said committee staff had repeatedly reached the CHAMP VA call line and heard messages estimating wait times "over two hours." Dr. Laurente acknowledged variability in call-center wait times — "in some cases, it could be as little as five to 10 minutes. In other cases, it could be as long as several hours" — and described interim steps: a callback feature, additional contractor surge support, workflow standardization and a planned online status-verification capability slated for 2026.

Officials and advocates also focused on providers’ ability and willingness to accept CHAMP VA payments. Jim Zinner, national policy director for the National Association of County Veterans Service Officers, said the program appears to pay "like or similar to Tricare" when CHAMP VA becomes the payer but that widespread provider confusion persists. He recommended provider education, expanding electronic submission capabilities (to allow accredited officers and service organizations to submit applications), clearer payment information, and a distinct, recognizable CHAMP VA ID card to prevent front-line staff from mistaking it for other VA or community-care cards.

Members raised geographic and data gaps as additional barriers to accountability. Representative King Hines highlighted the Northern Mariana Islands, telling the committee that in FY2023 the CNMI had 45 enrollees but only 15 users, a 33.3% utilization rate. Dr. Laurente said the VA does not yet systematically track wait times or granular beneficiary outcomes for territories and agreed to take territory-specific data requests for the record. She called a public provider directory a ‘‘first step’’ to assess adequacy of local networks and to target outreach.

Witnesses and members questioned whether statutory or regulatory changes are needed. Several members, including Ranking Member Brownlee and Representative Kiggins (who introduced related legislation), urged Congress to consider clarifying CHAMP VA’s administrative framework — including whether and how to require mandated electronic filings, clearer appeals paths (including third-party review), and whether CHAMP VA should be treated operationally more like an insurance product for practical reforms such as directories and predictable payment schedules.

VA officials described technical fixes underway. David Fennell, director of Veteran and Family Member Programs, said the VA has applied automation and business rules to streamline processing and that a separate queue for applications involving other health insurance (OHI) at one point numbered about 300,000; he said automation has reduced that queue to roughly 20,000 pending items and that many of these will be processed in real time as the new tools operate. On artificial intelligence, Fennell said the VA is currently applying business rules and beginning to add AI capabilities in newer cloud-based platforms for claims and eligibility.

The committee heard repeated calls for clearer communication to beneficiaries about application and claim status, consistent provider payment information, better provider outreach and training, and statutory clarifications to streamline appeals and eligibility verifications. Dr. Laurente pledged to provide additional information for the record where members requested data and to continue efforts on an automated application system and improved provider information.

The hearing concluded with members asking the VA to resume routine staff briefings so Congress can monitor progress and follow up on both systemwide fixes and individual cases raised at the hearing. Chairwoman Miller Meeks said the witnesses’ full written statements would be entered into the hearing record and adjourned the session.

The committee did not vote on legislation at the hearing; members said they expect continued oversight and potential follow-up hearings or requests for written responses on specific operational and statutory questions.