Sen. Jerry Moran, R-Kan., the chairman Senate Veterans’ Affairs Committee, speaks Tuesday, Jan. 28, 2025, during a hearing on private health care for veterans outside the Department of Veterans Affairs. (Eric Kayne/Stars and Stripes)

WASHINGTON — A lack of consistent policies and protocols by the Department of Veterans Affairs for administering private-sector health care for veterans is leading to medical records not being transferred, denials for appointments and a lack of understanding about reimbursements for clinicians who are not part of the VA system.

As the popularity of private-sector care continues to rise — with 40% of veterans’ medical services delivered in the community — lawmakers on Tuesday sought to examine the effectiveness of the dual system of public-private care. At a hearing of the Senate Veterans’ Affairs Committee, veterans and their families talked about their experiences receiving VA health care and private-sector care outside the VA.

“There are a lot of friction points for access to care,” said Navy veteran Eric Golnick, who runs a health care company that connects veterans with mental health services in their community. “There is not a standardized approach by the VA to making referrals” for care outside the VA system.

Sen. Jerry Moran, R-Kan., the committee chairman, said he has heard numerous stories by veterans about challenges and obstacles to accessing care and coverage outside the VA.

“The Mission Act was created so that the VA could more easily care for these veterans,” he said, adding the VA has in many cases discouraged and restricted the use of community care out of concern for losing funds.

The legislation was enacted in 2019 and enables veterans to seek medical care in the private sector when it is unavailable or not offered at a VA facility close to their home, Moran said.

Paige Marg of Texas, the wife of an Air Force veteran, told lawmakers that she repeatedly requested inpatient psychiatric care for her husband after he attempted suicide several years ago in a VA hospital parking lot. But the agency denied her requests, she said.

Paige Marg, whose husband is an Air Force veteran, testifies Tuesday, Jan. 28, 2025, during a meeting of the Senate Veterans’ Affairs Committee about her husband’s difficulties receiving care from the Department of Veterans Affairs. (Eric Kayne/Stars and Stripes)

Marg said she finally received help from the nonprofit Wounded Warrior Project, which paid for her husband’s six-week stay at a residential treatment facility where he received counseling and medical care for major depression and post-traumatic stress disorder, a mental health condition that afflicts people who have witnessed terrifying events.

“Wounded Warrior saved his life,” she said. “It is heartbreaking to see a spouse become a shell of a person and only to be discarded from the entity that should be providing him with care.”

But Marg said the VA later refused to reimburse Wounded Warrior Project for her husband’s care.

“VA should have covered it but failed to support him again,” she said.

Marg and her husband now avoid using VA services.

“How many veterans need to commit suicide for the VA to prioritize long-term mental health care?” she said.

Golnick told lawmakers that he considers VA and private sector care complementary services. But he said the VA lacks consistent standards for referring veterans to medical care with private doctors in their communities.

“Unclear eligibility requirements lead to delays and denials for veterans,” he said. “Some VA employees delay making referrals because it will affect their budget. Veterans — and not funding structures — should remain the priority.”

Sen. Richard Blumenthal, D-Conn., said there needs to be adequate funding in the VA budget for private-sector care and VA health services and infrastructure.

Sen. Richard Blumenthal, D-Conn., speaks Tuesday, Jan. 28, 2025, during a meeting of the Senate Veterans’ Affairs Committee. He said there needs to be adequate funding in the VA budget for private-sector care and VA health services and infrastructure. (Eric Kayne/Stars and Stripes)

“My fear is there will be an erosion, a starving of the VA. A shift will mean less investment in the VA system,” he said.

The VA is responsible for educating its employees about referring veterans to non-VA private sector care when VA services are not readily available, said Naomi Mathis, assistant national legislative director at the Disabled American Veterans.

The veterans group continues to support the VA as the “primary provider of veteran health care,” she said, adding it is a robust system that also provides medical research and emergency preparedness that benefits the entire nation.

But Mathis said her organization is hearing from veterans denied eligibility and access by the VA to private-sector care in their communities, when the service is not readily available at a nearby VA facility.

Veterans also are reporting delays in their medical records being transferred between VA facilities and private-sector doctors, as well as problems with private-sector clinicians billing the VA and receiving reimbursement.

Sen. Marsha Blackburn, R-Tenn., said the VA “has thrown up barriers” to veterans accessing private-sector health care.

Sen. Marsha Blackburn, R-Tenn., speaking Tuesday, Jan. 28, 2025, during a meeting of the Senate Veterans’ Affairs Committee. She has introduced legislation that allows veterans to directly schedule their own appointments for private health care at non-VA facilities.  (Eric Kayne/Stars and Stripes)

Blackburn last week introduced legislation called the Veterans Health Care Freedom Act that allows veterans to directly schedule their own appointments for private health care at non-VA facilities.

She said the legislation will build upon the success of the Mission Act in allowing veterans to access private-sector health coverage.

Existing rules require the VA to first approve a referral for outside care and then schedule the appointment. The process can add days and weeks to veterans obtaining care.

The legislation also would require the VA to inform veterans about their eligibility for private-sector care and provide a list of registered clinicians.