VA Health Care: Additional Assessments of Mileage Reimbursement Data and Veterans' Travel Costs Needed
Fast Facts
The Veterans Health Administration's mileage reimbursement benefit helps defray costs for eligible veterans who travel to receive medical care.
Veterans' use of the benefit declined during the COVID-19 pandemic when VHA shifted most care to telehealth. However, VHA doesn't know how different types of veterans use the benefit—which may be useful. For example, VHA may want to determine how often rural veterans use the benefit to access in-person care, as they tend to be less likely to have the broadband access necessary to access telehealth care.
We recommended, among other things, that VHA collect and assess this information.
VHA’s Mileage Reimbursement Claims, FYs 2010-2023
Highlights
What GAO Found
The Veterans Health Administration (VHA) uses the mileage reimbursement benefit to reimburse eligible veterans for use of personal vehicles to attend VHA-approved care. The benefit comprises (1) the mileage reimbursement rate—a per-mile amount VHA reimburses beneficiaries for travel to and from approved care and (2) a deductible—the amount VHA withholds from reimbursements with the purpose of limiting program costs.
According to officials, VHA tracks national trends of veterans' benefit use overall, but does not collect this information for subpopulations of veterans. GAO's analysis of VHA data show that veterans' use of the benefit increased from fiscal years 2010 through 2019 before declining in fiscal year 2020. In the last two fiscal years use increased, but remains below its peak. VHA officials attributed the decline to VHA's shift to telehealth in response to the COVID-19 pandemic. However, VHA does not collect information on how underserved subpopulations of veterans, such as rural veterans, use the benefit. This information could help VHA assess how changes in benefit use caused by the pandemic may have affected groups of veterans differently, which could help VHA determine how to address potential inequities. For example, VHA may want to determine how often rural veterans use the benefit to access in-person care, as they tend to be less likely to have the broadband access necessary to access telehealth care.
VHA has some information on travel costs for which veterans request reimbursement, such as tolls. However, VHA does not collect information on other travel costs, such as fuel costs, or assess how travel costs may vary across veteran subpopulations. Although VHA's reimbursement rate is set in statute, collecting additional travel cost information and assessing costs by subpopulations could inform future revisions to VHA's transportation programs aimed at optimizing their assistance for veterans. For example, VHA could use the information to revise the current eligibility model to consider travel to highly rural facilities for care.
GAO found, after the deductible, a veteran must travel at least 15 miles round trip to receive a reimbursement and 25 miles to have fuel costs covered.
A Veteran's Mileage Reimbursement per Mile Traveled Compared to Fuel Costs
Note: Reimbursement is based on the current mileage reimbursement rate of 41.5 cents per mile and a $6 round-trip deductible. The analysis assumes no other costs, such as maintenance, were incurred. GAO used the average fuel price in August 2023 of $3.95 per gallon and a fuel efficiency of 22.9 miles per gallon, the 2021 average fuel efficiency for light-duty vehicles.
Why GAO Did This Study
According to VHA, veterans' access to care is a multifaceted issue, and one in which disparities persist. VHA tries to improve access through the mileage reimbursement benefit, whose purpose is to defray beneficiaries' travel costs.
The Consolidated Appropriations Act, 2023, includes a provision for GAO to examine the Department of Veterans Affairs (VA) mileage reimbursement benefit. This report examines the information VHA has on veterans' use of the benefit and on veterans' travel costs, among other objectives.
GAO reviewed the VHA directive outlining VHA's requirements for administering the benefit and VHA data on veterans' use of the benefit from fiscal years 2010 through 2023. GAO also interviewed VHA officials who oversee the benefit; officials from three VHA health care systems, selected for variation in geography, among other things; and representatives from four veterans service organizations. Using fuel costs, GAO also analyzed the current rate and deductible to determine the distance a veteran would have to travel to receive a non-zero reimbursement.
Recommendations
GAO is making four recommendations to VA including that VHA should (1) collect and assess information on veterans' use of the mileage reimbursement benefit by subpopulation, such as rural veterans. VHA should also (2) collect additional information on veterans' travel costs and assess how costs vary by subpopulations. VA concurred or concurred in principle with GAO's recommendations and identified steps it plans to take to address them.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Veterans Affairs | The Under Secretary for Health should collect and assess information on subpopulations of veterans' use of the mileage reimbursement benefit and identify options, as appropriate, to help improve access to care for underserved veterans. (Recommendation 1) |
As of September 2024, we have not received an update from VA on actions taken to address this recommendation. When we confirm what action the agency has taken in response to this recommendation, we will provide updated information.
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| Department of Veterans Affairs | The Under Secretary for Health should collect additional information on veterans' travel costs and assess costs by demographic, geographic, or other subpopulations to inform evidence-based decisions about transportation programs' resources. This additional information could include fuel costs and the cost of vehicle maintenance, accessories, parts, and tires. (Recommendation 2) |
As of September 2024, we have not received an update from VA on actions taken to address this recommendation. When we confirm what action the agency has taken in response to this recommendation, we will provide updated information.
|
| Department of Veterans Affairs | The Under Secretary for Health should finalize and implement an outreach plan for improving veterans' awareness of aspects of the mileage reimbursement benefit. The plan should include outcome-oriented performance measures and appropriate communication methods, based on factors such as the intended audience. (Recommendation 3) |
As of September 2024, we have not received an update from VA on actions taken to address this recommendation. When we confirm what action the agency has taken in response to this recommendation, we will provide updated information.
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| Department of Veterans Affairs | The Under Secretary for Health should evaluate the effectiveness of the outreach plan for improving veterans' awareness of the benefit, and revise communication methods as appropriate. (Recommendation 4) |
As of September 2024, we have not received an update from VA on actions taken to address this recommendation. When we confirm what action the agency has taken in response to this recommendation, we will provide updated information.
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