WASHINGTON, D.C. — Maine’s Congressional Delegation wrote to the Department of Veterans’ Affairs (VA) Secretary Denis McDonough requesting an update on a rule that would allow VA to reimburse Maine Veterans’ Homes (MVH) for nursing home care for veterans with dementia. In the letter, U.S. Senators Susan Collins and Angus King, a member of the Senate Veterans’ Affairs Committee, and U.S. Representatives Chellie Pingree and Jared Golden, stressed that the ongoing delay in finalizing the reimbursement rule is causing significant financial harm to veterans, their families and MVH.

In 2020, Congress passed legislation authorizing the VA to cover the costs of nursing home care provided by state veterans’ homes for veterans with early stage dementia. The VA delayed its proposal of the required rulemaking by more than two years. This delay forced MVH, and in some cases veterans and their families, to pay out-of-pocket for the care costing approximately $130,000 per month and over $3 million since 2019.

“We write to request an update on the finalization of the proposed rule 88 FR 60417 for eligible veterans to receive per diem domiciliary care payments at state veterans’ homes. There is no finalized rule three years after the law was passed and six months since the proposed rule was announced. This delay continues to cause financial harm to our veterans, their families, and Maine Veterans’ Homes (MVH), who have continued to serve deserving veterans while waiting for the proper implementation of this law. We urge the quick finalization of this rule without further delay,” wrote the Delegation.

There are currently 118 veteran residents requiring domiciliary care at Maine Veterans’ Home. For the 92 veterans not grandfathered in before 2020, they, their families, or Maine Veterans’ Home must pay out of pocket for their needed care, which can easily be over $1,500 a month. This intolerable cost needlessly burdens veterans and Maine Veterans’ Homes… Due to the increasing number of residents requiring this care and the rising costs of inflation and wages on healthcare costs, Maine Veterans’ Homes has lost approximately $130,000 per month due to denied VA domiciliary care per diem reimbursements. At this rate, Maine Veterans’ Home expects to lose $3.9 million by the end of this fiscal year if nothing is done,” continued the Delegation.

Domiciliary care was established by the VA after the Civil War as a type of assisted living that is provided to older veterans who are independently mobile, or semi-mobile and incapable of living alone. Over 115 MVH residents receive domiciliary care, 80 percent of whom are on Medicaid.

The care was federally reimbursed for years until 2019, when the VA abruptly ended payments. The Veterans Health Care and Benefits Improvement Act, signed into law on January 5, 2021, authorized the VA to resume reimbursements for domiciliary care at state homes like MVH. After pressure from the Maine delegation, in September 2023 the VA announced a proposed rule that would retroactively reimburse MVH for the care they’ve provided back to January 2020, but the VA has yet to announce a finalized rule that would allow MVH to receive the payments.

Created by the Maine Legislature in 1977, Maine Veterans’ Homes is an independent nonprofit organization that provides services to Maine veterans at six homes in Maine, located in Augusta, Bangor, Caribou, Machias, Scarborough and South Paris. Their care includes rehabilitative care, domiciliary care, nursing care and end of life care.

The Maine Congressional delegation has continuously pushed the VA to reimburse Maine Veterans’ Homes. In September, the delegation announced the VA had agreed to resume reimbursing Maine Veterans’ Homes for domiciliary care, but sixth months later the rule has yet to be finalized. Last May, the delegation introduced the Reimburse Veterans for Domiciliary Care Act, which would require the Department to begin payments for current care as mandated by law and retroactively provide MVH with the reimbursements for past care.

You can read the full letter here or below.

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Dear Secretary McDonough,

We write to request an update on the finalization of the proposed rule 88 FR 60417 for eligible veterans to receive per diem domiciliary care payments at state veterans’ homes. There is no finalized rule three years after the law was passed and six months since the proposed rule was announced. This delay continues to cause financial harm to our veterans, their families, and Maine Veterans’ Homes (MVH), who have continued to serve deserving veterans while waiting for the proper implementation of this law. We urge the quick finalization of this rule without further delay.

As you are aware, the Department of Veterans Affairs (VA) reimbursed this service for 15 years but abruptly changed course in 2019. The bipartisan fix was contained in the Veterans Health Care and Benefits Improvement Act, signed into law on January 5, 2021. Specifically, section 3007 of that law authorizes the VA to waive existing eligibility requirements for a veteran to receive per diem payments for domiciliary care at a state home. Despite the clear mandate of this law, we are still waiting on the finalized rule. This delay is unacceptable and puts veterans at risk.

There are currently 118 veteran residents requiring domiciliary care at Maine Veterans’ Home. For the 92 veterans not grandfathered in before 2020, they, their families, or Maine Veterans’ Home must pay out of pocket for their needed care, which can easily be over $1,500 a month. This intolerable cost needlessly burdens veterans and Maine Veterans’ Homes.

Between January 2020 and November 2023, Maine Veterans’ Home lost $3 million caring for their domiciliary care residents. Due to the increasing number of residents requiring this care and the rising costs of inflation and wages on healthcare costs, Maine Veterans’ Homes has lost approximately $130,000 per month due to denied VA domiciliary care per diem reimbursements. At this rate, Maine Veterans’ Home expects to lose $3.9 million by the end of this fiscal year if nothing is done.

We support the September 2023 proposed rule’s retroactive payments back to January 2021 and the expanded eligibility standards for receiving domiciliary care. These important changes will help make veterans and Maine Veterans’ Home financially whole. The proposed rule, if finalized, will also allow Maine Veterans’ Home to better serve veterans with dementia.

We expect that the Department will act expeditiously in finalizing this rule. We look forward to continuing to support the VA in its efforts to enhance the care of veterans who have served our country. 

Sincerely,

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