At Hearing, Tester Seeks Answers from Administration Officials on Improving Veterans’ Access to Long-Term Care & Addressing Nursing Home Staffing Shortages

VA confirms they’re “on pace” to expand the Veteran Directed Care program to all VA medical centers; Tester highlights low Medicaid reimbursement rates negatively impacting veterans in rural Montana

In his continued effort to support veterans across rural America, Chairman Jon Tester led a Senate Veterans’ Affairs Committee hearing yesterday where he pushed officials from the Department of Veterans Affairs (VA) and Centers for Medicare and Medicaid Services (CMS) to improve access to quality long-term care.

“The Veteran Directed Care [VDC] program provides veterans the opportunity to receive long-term care services in their homes by providing them with the budget to hire workers to assist them with certain activities,” said Tester. “On the 18th of April, President Biden released an Executive Order which, among others things, directed VA to consider expanding VDC to all VA medical centers by the end of next year…would you give us an update on the projected timeline for expanding that program to all VA medical centers?”

“Currently we’re on pace to meet that guideline,” replied Dr. Scotte Hartronft, the Executive Director of VA’s Office of Geriatrics and Extended Care.

In April, a group of Senators blocked a vote to advance the Elizabeth Dole Veterans Programs Improvement Act. The legislative package, which Tester led the Committee in advancing unanimously in February, includes the Dole Home Care Act (Dole Act) to improve veterans’ access to home and community-based care. The Chairman’s opening statement, submitted into the record, underscored the urgent need to pass the package in the Senate to expand veterans’ access to high quality long-term care.

During the second panel, Paralyzed Veterans of America (PVA) Executive Director Carl Blake stressed the importance of putting politics aside to pass Tester’s critical legislation for veterans, including veterans who are paralyzed or live with disabilities: “Our members are tired of political posturing, and election year politics that are standing in the way of much-needed reforms like the Dole Act, like the CAREERS Act, like the BUILD Act… Just get it done. Do the right thing.”

Tester also heard from Ms. Carla Wilton, Chief Operating Officer of Immanuel Lutheran Communities—a long-term care facility in Kalispell, Montana—on how low Medicaid reimbursement rates have limited access to senior care in rural states like Montana.

“Low Medicaid reimbursement rates often leave nursing homes with no choice but to close their doors…what are the kind of decisions you have to make when those rates for reimbursements are too low to cover the costs?” Tester asked. 

“[I]t’s difficult…and this has been going on for decades in Montana—rates haven’t been high enough,” Ms. Wilton. “…The difficult decisions we have to make are [in] considering how many residents we can serve with the staff we can afford to have. And it’s a fine balance.”

Tester has also led the charge in opposing CMS’ intention to issue blanket staffing mandates that could hurt rural nursing homes. These staffing mandates, if implemented, would apply to many State Veterans Homes and VA-contracted Community Nursing Homes—placing an enormous financial burden on these facilities and potentially decreasing access to care for veterans. 

This Congress, Tester is continuing his push to bolster VA’s capacity by providing VA with more tools to recruit and retain medical personnel with his bipartisan VA CAREERS Act and strengthen VA infrastructure with his BUILD for Veterans Act.


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