November marks National Family Caregivers Month — an important time to recognize the sacrifices and dedication of the heroes who stand in the shadows caring for the needs of wounded, ill, injured, and disabled servicemembers and veterans.

MOAA has long served as an advocate for caregivers, successfully lobbying to expand and improve VA caregiver benefits and programs. This includes supporting the creation of the Program of Comprehensive Assistance for Family Caregivers (PCAFC), which VA expanded last month to include veterans of all eras.

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PCAFC is a unique program focused on supporting veteran caregivers. The VA is the only health system in the country that provides comprehensive, wraparound services for caregivers of eligible veterans, to include a monthly stipend; education, financial and legal assistance; health insurance; beneficiary travel; peer support; and other resources to aid the family caregiver in caring for their loved one.

Congress directed the VA to expand the program in the 2018 MISSION Act. Implementation problems and delays have plagued program implementation since expansion began Oct. 1, 2020. Problems in setting up a new case management system delayed the rollout of the first expansion phase until October 2021; that expansion covers caregivers of veterans who entered service on or before May 7, 1975.

Throughout FY 2022, the program struggled in reassessing legacy veteran caregivers to determine eligibility under the new program, which resulted in high denial rates or discharges from the program. The department also had difficulty implementing the program regulations consistently across its health system and communicating the program eligibility and requirements to veterans and their caregivers.

2022 in Review

After an ongoing barrage of criticism and demand for PCAFC reform from veterans, caregivers, families, veteran service organizations (VSOs), and members of Congress, the VA got the message. Earlier this year, Secretary Denis McDonough committed to reviewing the program and offering recommendations to Congress for improving the program, acknowledging PCAFC was not meeting the intent of lawmakers’ vision of the MISSION Act.

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The VA has since been working closely and diligently with caregivers, veterans, VSOs, and other stakeholders – including lawmakers – to determine what changes the department is able to make under its current authority and what improvements will require legislative action. VA conducted several summits and listening sessions in 2022 and continues to engage regularly with MOAA and our VSO partners, working collaboratively to produce recommendations for program improvements.

The following are some key actions taken by the VA to honor the secretary’s commitment:

• March 22 — VA halts all expulsions from the caregiver support program so officials can reevaluate the new eligibility criteria for family caregivers receiving monthly stipend support. This was the third time the VA halted the program during implementation, following an April 2017 stoppage to fix administrative inconsistencies and a December 2018 delay caused by inconsistencies in VA medical centers applying eligibility requirements.
  
  
• June 9 — The department indefinitely suspended certain discharges and stipend reductions for those family caregivers under the legacy program to review program qualifications. The VA committed to no reductions in stipends based on a recent VA reassessment of a veteran-caregiver qualifications and no discharges from the program until the review was complete.
  
  
• Sept. 15 — The VA announced the extension of legacy veterans and their family caregivers in the program through September 2025. During this time, no legacy applicant or legacy participant, or their family caregiver, will be discharged or experience any decrease in support provided through PCAFC, including the monthly stipend. The extension will allow the VA “to continue supporting this cohort of veteran caregivers, while VA separately conducts program improvement initiatives aimed at ensuring the [PCAFC] addresses the unique needs of veterans of all eras and their caregivers,” VA Caregiver Support Program (CSP) Executive Director Colleen M. Richardson, Psy.D, said in the press release announcing the move.
  
  
• Oct. 1 — The VA executes the second phase of PCAFC expansion of the MISSION Act for those veterans who served after May 7, 1975, and before Sept. 11, 2001, opening the program to veterans of all eras. The move meant that “for the first time, eligible veterans of all service eras can participate in the VA’s Program of Comprehensive Assistance for Family Caregivers,” Deputy Secretary of Veterans Affairs Donald Remy said in the October announcement. “We recognize the critical role family caregivers play in caring for veterans, and through this expansion, we’re able to ensure that family caregivers of all eligible veterans have access to the comprehensive support they deserve.”

The VA has enrolled about 33% more veterans in the PCAFC as of Oct. 1 than this time last year. The department also has reduced processing time for those applying for the program significantly — 84% of all applications received and processed were completed within 90 days, a 34% year-over-year improvement.

What to Expect in 2023

The VA has designated this fiscal year as “The Year of the Caregiver.” Officials will focus on continuing to implement the PCAFC expansion, conducting the overall program review, and making systemwide improvements, to include cases being appealed through the Veterans Health Administration and Veterans Benefits Administration.

Top priorities for the program include:

• Enhance respite service. The CSP is establishing caregiver respite liaisons to support access and coordinate services. Respite care is a critical component of supporting the health and well-being of caregivers. Liaisons will serve as regional respite champions and PCAFC subject-matter experts.
  
  
• Implement caregiver mental health resources. The MISSION Act requires the VA to provide counseling, training, and mental health services (excluding medication management) to caregivers enrolled in PCAFC. The CSP is piloting a project with the VA Office of Mental Health and Suicide Prevention to provide mental health services through clinical resource hubs. These hubs will create specialized centers to better support and align mental health services to meet the unique needs of caregivers. Care will primarily be delivered virtually, but caregivers will also be able to access in-person care. If successful in the first wave of implementation, set to run through March 2023, the initiative will roll out in two additional waves sometime in FY 2024.
  
  
• Improve the caregiver and veteran experience. Veterans and caregiver experiences are important to the VA. The department has developed a customer experience survey to capture the voice of the caregiver and veteran so it can make ongoing improvements.
  
  
• Increase communication around decision-making. New decision review and appeal workstream enhancements and technology solutions continue to be developed to improve communications and documentation in VA’s electronic health record. This will allow caregivers and veterans, as well as the VSOs assisting them, easier access important medical information related to the program.
  
  
• Establish legal and financial services. The MISSION Act directed the VA to offer these services, with the goal of increasing the capability of primary family caregivers to manage their own personal finances and those of the eligible veteran, where applicable. The VA has awarded a contract, and VSOs hope to learn more about when and how the VA expects to roll out these services.

More PCAFC History

In 2010, MOAA lobbied successfully to get the Caregivers and Veterans Omnibus Health Services Act (Public Law 111-163) signed into law. It provided comprehensive support services and benefits directly to family caregivers of eligible veterans with a serious injury incurred or aggravated in the line of duty on or after Sept. 11, 2001. The PCAFC included education and training, respite care, mental health services, beneficiary travel, a monthly stipend payment, and access to health care through the CHAMPVA program to individuals with no health insurance coverage.

Almost eight years later, MOAA and dozens of other organizations representing millions of veterans scored another important legislative milestone with the VA MISSION Act, one of the most historic pieces of veterans’ health care legislation in decades. The bill expands the comprehensive caregiver assistance program to veterans of all eras.

MOAA commends VA and especially the work that has been done under the leadership of Dr. Richardson, the CSP executive director. The entire CSP team is collaborative, transparent and exceptionally dedicated to its work; its members genuinely care about getting this program right for veterans and their family caregivers. What they have done and plan to do is phenomenal, and MOAA looks forward to helping her team achieve these important and necessary program improvements.

If you are enrolled in PCAFC or are using VA caregiver support services, MOAA would like to hear your thoughts on how the program is working and how the VA is supporting your needs. Please send your comments to msc@moaa.org.