VA Health Care: Estimates of Available Budget Resources Compared with Actual Amounts Page: 2 of 23
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services provided in veterans' own homes and in other locations in the community.3
VA also provides some services that are not part of its medical benefits package,
such as nursing home care.4
The amount of funding VA receives to provide its health care services is determined
by Congress in the annual appropriations process. Congress provided new
appropriations5 of about $48.2 billion for fiscal year 2011 and advance
appropriations of $50.6 billion for fiscal year 2012 for VA health care.6 In preparation
for the appropriations process, VA must annually develop a budget estimate of the
resources that it believes are needed to provide its health care services. This
estimate is subsequently used to help inform the President's formal budget request
for appropriations for VA health care.7
VA's annual budget estimate for a fiscal year includes estimates of the resources
available to provide VA health care services.8 This includes an annual estimate of
the amount of resources expected to be available from collections and
reimbursements that VA anticipates it will receive in the fiscal year. It also includes
an estimated amount of resources VA has not spent-known as an unobligated
balance-that VA is authorized to carry over into the following fiscal year from the
previous one.9 VA's collections include third party payments from veterans' private
health care insurance for the treatment of nonservice-connected conditions and
veterans' copayments for outpatient medications. VA's reimbursements include
amounts VA receives for services provided under service agreements with the
3VA provides adult day health care, respite care, and other noninstitutional long-term care services as
part of the medical benefits package provided to all enrolled veterans. See 38 U.S.C. 1701(6)(E),
1710B; 38 C.F.R. 17.38.
4VA is required by law to provide nursing home care to certain veterans needing such care who also
have service-connected disabilities, and VA also makes nursing home care available to other
veterans on a discretionary basis as resources permit. See 38 U.S.C. 1710A.
5We use the term "new appropriations" to refer to the appropriations provided during the current
annual appropriations process for the upcoming fiscal year and, in the case of "advance
appropriations," appropriations provided for the following fiscal year.
6Veterans Health Care Budget Reform and Transparency Act of 2009, Pub. L. No. 111-81,
3, 123 Stat. 2137, 2137-38 (2009), codified at 38 U.S.C. 117, provided that VA's annual
appropriations for health care include advance appropriations that become available 1 fiscal year
after the fiscal year for which the appropriations act was enacted.
7See GAO, Veterans' Health Care: VA Uses a Projection Model to Develop Most of Its Health Care
Budget Estimate to Inform the President's Budget Request, GAO-11-205 (Washington, D.C.: Jan. 31,
2011); and GAO, Veterans' Health Care Budget Estimate: Changes Were Made in Developing the
President's Budget for Fiscal Years 2012 and 2013, GAO-11-622 (Washington, D.C.: June 14, 2011).
8VA's annual budget estimate for a fiscal year also includes estimates of the resources needed to
meet the expected demand for VA health care services. As we have previously reported, VA uses
what is known as the Enrollee Health Care Projection Model (EHCPM) to develop most of its estimate
of the resources needed to meet the expected demand for VA health care services, and VA uses
other methods to develop the remainder of the estimate. See GAO-11-205.
91n addition to new appropriations that VA may receive from Congress as a result of the annual
appropriations process, funding may also be available from unobligated balances of multiyear
appropriations, which remain available for a fixed period of time in excess of 1 fiscal year. For
example, VA's fiscal year 2012 appropriations provided that about $1.75 billion be available for
2 fiscal years. These funds may be carried over from fiscal year 2012 to fiscal year 2013 if they are
not obligated by the end of fiscal year 2012. See Pub. L. No. 112-74, 227(b), 125 Stat. 786, 1159
GAO-12-383R VA Budget Resources
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United States. Government Accountability Office. VA Health Care: Estimates of Available Budget Resources Compared with Actual Amounts, text, March 30, 2012; Washington D.C.. (digital.library.unt.edu/ark:/67531/metadc301323/m1/2/: accessed February 22, 2019), University of North Texas Libraries, Digital Library, digital.library.unt.edu; crediting UNT Libraries Government Documents Department.