HHS and VA Health Insurance Dual Eligibility Disconnect for Disabled Veterans

At Hof, we are committed to advocating for clarity and fairness in government policies, practices and procedures that impact the lives of America's approximately 1,107,440 veterans assigned a 100 percent evaluative rating by the Department of Veterans Affairs' (VA) Veterans Benefits Administration (VBA). Recently, we identified a critical inconsistency between the guidance provided by the VA and the actual practices and procedures of the Department of Health and Human Services (HHS), relating to health insurance coverage options on HHS's online marketplace for veterans assigned a 100 percent evaluative rating.

As of 2023, America has 1,107,440 veterans assigned a 100 percent evaluative rating by the VBA, according to publicly available data.

The Issue

The VA’s website has long encouraged veterans receiving healthcare at the VA's Veterans Health Administration (VHA), i.e., disabled veterans, to obtain and maintain secondary health insurance coverage. Inevitably, this means that a large portion of folks receiving such guidance are turning to the Department of Health and Human Services' (HHS) Health Insurance Marketplace for such secondary health insurance coverage. However, in practice, veterans who attempt to secure such coverage through the HHS Health Insurance Marketplace are routinely denied; as of late 2024 and early 2025, HHS requires applicants to justify why their primary coverage through the VHA is insufficient, creating unnecessary confusion and administrative burdens for veterans who already face significant challenges.

At the end of the day, HHS is not permitting 100 percent disabled veterans to receive secondary health insurance coverage, given the fact, among other things, that they pay no copays or coinsurance as members of Priority Group Numbered One at VHA.

"The issue could be even more expansive, extending beyond veterans assigned a 100 percent evaluative rating to include veterans assigned lower ratings or who are members of lower priority groups. We just don't know, Joseph Anthony Hof, Managing Attorney of Hof Law, was quoted as saying, "that is because the only case that the firm knows of personally relates to a 100 percent disabled veteran assigned to priority group numbered one, but there are vastly more veterans assigned ratings lower than 100 percent, such as from ten to 90 percent. There are, too, priority groups numbered one to eight at VA. We just don't know when HHS starts to permit disabled veterans to receive secondary coverage on the Health Insurance Marketplace. Having said that, it is the firm's belief that veterans assigned a sixty percent evaluative rating who are assigned to Priority Group Numbered One are able to receive secondary health insurance coverage on the Health Insurance Marketplace, while those assigned a 90 percent evaluative rating, and up, are not," Joe added.

Our Coordinative Efforts

Recognizing this problem, our firm engaged directly with HHS, particularly with folks in Kansas City who are former members of the now-defunct Federal Executive Board there, to highlight the issue and advocate for a clear and actionable solution. Between December 2024 and March 2025, Member Hof encouraged folks of HHS to work collaboratively with the folks of the VA to amend the VA's website guidance, ensuring that 100 percent disabled veterans receive accurate information about the limitations they will face when attempting to obtain secondary health insurance coverage through the Marketplace.

As of March 13, 2025, Hof believes that the VA's Central Office (VACO) in Washington, DC, will modify the website accordingly.

On March 23, 2025, the firm contacted the Bipartisan House Department of Government Efficiency (DOGE) Caucus to praise the Federal government for their coordinative efforts that led to the forwarding of the issue from HHS to VACO; to inform the Legislative Branch of the problem; and to ask The Hill to stay on top of VACO to ensure that VA's external messaging about secondary health insurance coverage availability and VHA-enrolled veterans is updated in accordance with the reality faced by such veterans at HHS. The recommendation was the twelfth proposal that the firm has transmitted to the Bipartisan House DOGE Caucus since President Trump was inaugurated on January 20, 2025. (DOGE 12.0).

The Results

Through our efforts, HHS acknowledged the issue and committed to working with the VA to update its website guidance. This update will provide clear and accurate information to veterans, sparing them from frustrating and time-consuming interactions with HHS based on misleading expectations.

Recognizing HHS Region 7’s Leadership

We extend our sincere appreciation to HHS Region 7 in Kansas City for their responsiveness and commitment to addressing this issue. Their leadership and willingness to collaborate with the VA will lead to a significant improvement in the customer service experience for America’s 100 percent disabled veterans.

The Outcome: A Better Experience for Veterans

Once the VA implements the necessary website updates, veterans will no longer read misleading guidance that sets them up for failure and unnecessary frustration at HHS. Instead, they will have access to clear, accurate, and transparent information regarding the availability of their healthcare coverage options, allowing them to make informed decisions without unnecessary bureaucratic obstacles.

Hof is proud to have played a role in resolving this issue, and the firm remains dedicated to ensuring that veterans receive the respect, clarity, and support they deserve. If you are a veteran or advocate facing similar challenges, we encourage you to reach out.