Mr. Chairman and Members of the Subcommittee:

My name is Keith Ribbentrop. I am the State Veterans’ Home Liaison Officer to the Yukio Okutsu State Veterans Home in Hilo Hawaii.  I am retired from the United States Air Force, and as a disabled combat veteran of the Vietnam War, I am here today,  grateful for the opportunity to advocate for my comrades-in-arms.  Thank you for the honor to speak on their behalf.

The Veterans Benefits, Health Care, and Information Technology Act of 2006 (Pub. L. No. 109-461) authorized the United States Department of Veterans Affairs (VA) to make payments to State Veterans Homes that provide nursing home care to certain veterans with service-connected disabilities (also known as the 70% Program).

VA regulations implementing section 211(a) of the statute that took effect earlier this year purport to provide a higher per diem rate for 70% Program eligible veterans.  However, the program as implemented has actually resulted in significantly lower payments to many State Veterans Homes. Unless revised, the 70% Program will not provide the actual cost of care to State Veterans Homes despite congressional intent. 

The problem is particularly urgent for states that are Medicare and Medicaid (CMS) certified.  There are 30 states across the nation with CMS certified Homes, one of which is Hawaii.  Our Home receives payment for the care of veterans with service-connected disabilities for a limited period of time under the Medicare program.    However, those veterans eligible for the higher per diem rate are not eligible for Medicaid funds. The following table and charts reflect that as the number of veterans eligible for the higher per diem rate increases (1200% in Hawai’i since June 2009), the disparity between per diem and cost increases as well thereby threatening the State Homes’ viability. 

1  Actual expenses incurred by 70% program eligible veterans for the number in-residence days at the State Veterans Home under the 70% Program.

2  Daily VA per diem rate from February through October 2009 $331.35; from October 2009 through December 2009 $330.98.

I believe the VA has done all that it can under current law.   However, the VA’s administrative measures only relieve a portion of the financial burden.  Hawai’i Island, where the State Veterans Home is located, suffers from a critical shortage of doctors (see attachment) as well as specialty medical services.  This shortage requires transport of a resident 200 miles by air to the island of Oahu where care would be available.  

The rapid growth of the 70% Program eligible veterans in our Home is duplicated nationwide. Because of this growth and the financial implications, many states have constrained admission of veterans under the new program.  The Yukio Okutsu State Veterans Home is proud to report that it is nearing capacity.  We are 99% filled and soon will need to establish a waiting list.  Our Home’s wait list is established with priority given to service connected disabled veterans by rank order of disability rating.

 The 70% Program has been a blessing for many veterans and their families.  As the Yukio Okutsu State Veterans Home – Hilo reaches capacity, Mr. Mark Moses, State Director, Office of Veterans Services has begun to assess the need for Hawaii’s next State Home.  The 70% Program will have a profound impact on his planning and implementation.

The National Association of State Veterans Homes has proposed technical amendments to the 70% Program that are reflected in H.R. 4241, introduced by Representative Michael H. Michaud, a member,  House Committee on Veterans’ Affairs.  The amendments contained in H.R. 4241 will allow all State Veterans Homes greater flexibility for admission and for care of veterans with service-connected disabilities without jeopardizing the future of the Homes. As you and the Committee on Veterans’ Affairs deliberate H.R. 4241, please know that it will be beneficial to both veterans as well as the Homes built to serve them.  I urge you to support this measure.

Mr. Chairman, thank you for your dedication, and the dedication of the Committee on Veterans’ Affairs in support of our nation’s veterans.

Physician Needs Estimate Provided by Hilo Medical Center