Increased Funding From VA For Home-Based Care Stripped From Dole Act

This month, the Senate Veterans Affairs Committee removed a provision in the Elizabeth Dole Home Care Act that would have increased funding for home- and community-based services.

The decision was a disappointing one for home-based care advocates. It came in the final moments before the piece of legislation was finalized.

“We started out this new session identifying it as one of our priorities,” Vicki Hoak, CEO of Home Care Association of America (HCAOA), told Home Health Care News. “We recently heard that the Elizabeth Dole Act was going to move forward, but they were going to eliminate the section that we care the most about.”


Today, the U.S. Department of Veterans Affairs is permitted to fund 100% of the costs for a nursing home stay. If someone decides to – or needs to – stay at home, however, the VA can fund up to 65% of the costs.

Section 3 of the Elizabeth Dole Act would have bumped that number up to 100%, a measure Hoak and other advocates had been working on for years.

“We still have to play catch up in a lot of these programs, and this is one that was really disappointing,” Hoak said. “Because everyone knows that people would prefer to stay in a home for as long as possible. When this bill was introduced, it was going to increase that funding to 100%, therefore veterans would truly have a choice.”


Before any legislation is passed, a Congressional Budget Office (CBO) score must be calculated to determine how much legislation changes would cost the government.

In this case, the government estimated the cost of increasing HCBS funding showed a 35% increase in non-institutional costs over 10 years. That was the reason why the committee removed the provision.

However, Hoak and the HCAOA believe the committee did not calculate the savings that would come from shifting care to a more preferred and cost-effective setting.

“The current cap on in-home care does not necessarily reduce the department’s health care obligations to veterans, it just redirects them to the least preferred care setting and most costly,” Hoak wrote in the letter to the committee.

Today, more than 20,000 veterans receive in-home care under the VA Community Care Network through more than 5,000 home care agencies. The provision cut from the bill would have likely increased those numbers.

Now, when veterans hit their 65% cap, the VA will still cover the remaining costs, but will be forced to send those patients to a nursing home if more care is needed.

“Under the current program, when you hit that cap, the VA is still going to take care of you, but it’s almost like they’d be pushing people toward the least preferred and the most costly option,” Hoak said.

Looking ahead, Hoak said HCAOA members – and other home-based care providers – are encouraged to send messages to members of Congress to urge them to keep the Dole Act intact and oppose efforts that eliminate or reduce increased funding for HCBS.

“The president, during his State of the Union speech, mentioned that we have to take care of our veterans when they come home,” Hoak said. “I think everyone is in agreement, we just have to get past some of these [misunderstandings]. We’ve got to give veterans a choice, their families a choice. That’s why this is really important to us.”

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