At Joint Hearing, Tester Highlights Urgent Need to Fix Restrictive Rules in VA Caregivers Program

Senator heard from advocates and a Montana caregiver about challenges with current services for caregivers and legislation to improve support

During a joint Senate Veterans’ Affairs Committee and Senate Aging Committee hearing today focused on improving support for veteran caregivers, Chairman Jon Tester heard from a Montana veteran caregiver on her experience with the Department of Veterans Affairs’ (VA) Program of Comprehensive Assistance for Family Caregivers (Caregivers Program) and its restrictive regulations that went into place in 2020. Her husband’s combat injuries resulted in a 100 percent permanent and total disability rating by the Veterans Benefits Administration in 2016, but after a reassessment in 2021, the Nieskens were dropped from the program.

“The…problem here from my perspective is [the] regulations published almost four years ago in July 31, 2020 that went into effect October 1, 2020.” said Tester. “You’ve been taking care of your husband for nearly 20 years. Can you tell me what it was like before those [Caregivers Program] regulations went into effect?”

“Before the regulations went into effect, I felt supported…and I had assurances that I would be able to navigate his care successfully,” said Hannah Nieskens, a Montanan from Cardwell who serves as a caregiver to her husband Kelly, a Post-9/11 veteran who served in the Montana Army National Guard. “Once those regulations passed, we were dismissed from the Caregiver Program…we feel like we’re in a purgatory situation here where we just don’t know what the next iteration of these regulations will look like.”

Nieskens and her husband were dismissed from the program as a direct result of the restrictive eligibility requirements, despite his condition remaining the same. Tester questioned her on the impact being discharged has had on her family, and Nieskens underscored the uncertainty it has created in addition to the financial impact of a “significant portion” of their income going away.

During the hearing, Tester also questioned witnesses on how his Elizabeth Dole Home Care Act, a provision included in the Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act, would benefit veteran caregivers like Nieskens.

“Meredith, I appreciate your comment earlier that we’ve got some really good bills that actually get things done and get hung up because of politics of the day. You’re spot on and quite frankly, it ain’t right,” said Tester. “Good policy is good policy regardless of political party and regardless of who’s carrying it…I want you to summarize and particularly highlight why [the Elizabeth Dole Home Care Act] is so important for our nation’s caregivers.”

Meredith Beck, the National Policy Director for the Elizabeth Dole Foundation, stressed the legislation would help improve veterans’ and family caregivers’ access to home and community-based care.

Beck highlighted a provision in the legislation that would increase the amount VA can spend on a veteran’s home-based care from 65% to 100% of the cost of nursing home care: “I have caregivers watching right now who are waiting every single day to ensure that they are able to get the services they need in the home to keep the veterans they care for in their home. Those are individuals who have long-term ALS, MS, severe traumatic brain injuries, and without the removal of that cap…they will potentially have to move to a nursing home.”

Tester led the fight for years to expand the Caregivers Program to veterans of all eras—successfully including language in the bipartisan VA MISSION Act of 2018. However, in 2020 VA defied Congress’ intent and the concerns of veterans and caregivers by enacting regulations that narrowed the program’s eligibility to veterans with a 70 percent or higher service-connected disability rating, and those with an inability to perform an activity of daily living without assistance each and every time the activity occurs.

Since the implementation of the restrictive regulations, Tester has continuously raised concerns and called on the Department to fix its tightened eligibility of the Caregivers Program. Following Tester’s efforts, VA started making sweeping changes to the program in March of 2022, including immediately halting the discharge of legacy participants and working to start a new process to refine eligibility requirements to ensure the program is meeting the intent of Congress.


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