CHAMPVA
Overview
Background
HISTORY
In 1973, the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) was established as a health benefits program for dependents of permanently and totally disabled veterans, as well as the survivors of veterans who died from a service-connected condition, or who at the time of death, were rated permanently and totally disabled from a service-connected condition.
From 1973 through 1986, CHAMPVA application processing and eligibility determinations were completed by VA medical centers. In 1986, the Veterans Health Administration (VHA) established the CHAMPVA Center in Denver and transferred the responsibility of determining beneficiary eligibility to this center.
From 1973 through 1990, the VA contracted with the Department of Defense’s (DoD) Office of Civilian Health and Medical Program of the Uniformed Services OCHAMPUS to process all CHAMPVA claims. In December 1990, the DoD began transferring claims processing responsibilities from OCHAMPUS to the CHAMPVA Center.
By January 1, 1994, the CHAMPVA Center was fully operational and processed all claims, beneficiary eligibility determinations and payments for beneficiaries. In 1996, the CHAMPVA Center was officially renamed the Health Administration Center (HAC).
ADMINISTRATION
CHAMPVA is administered by the Health Administration Center (HAC) of the Department of Veterans Affairs. HAC administers all CHAMPVA activities, including the verification of eligibility of benefits, authorization of benefits and services, vendor certification and approval, payment methodologies and the authorization of medical services and supplies.
FUNDING
CHAMPVA is funded through federal appropriations from Congress.
Summary of CHAMPVA
The Civilian Health and Medical Program (CHAMPVA) is a comprehensive fee-for-service health insurance plan for the dependents and caregivers of certain U.S. veterans. It covers most healthcare services and supplies that are medically and psychologically necessary.
To be eligible for CHAMPVA an individual must be a qualifying spouse, surviving spouse, or the child of a veteran who is rated permanently and totally disabled due to a service-connected disability, or was rated permanently and totally disabled due to a service-connected condition at the time of death, or died of a service-connected disability, or died on active duty. In addition, the dependents cannot be eligible for TRICARE benefits. Eligible dependents must apply for CHAMPVA.
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Caution: The information contained in this chapter does not cover the many complexities that exist in with the CHAMPVA program. There may be exceptions to eligibility that are not listed in this chapter. Therefore it is advisable to find additional information if a dependent does not meet the criteria listed in this chapter. |
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Health Programs
- CHAMPVA
- Overview
- Description of Civilian Health And Medical Program
- Qualifying for Civilian Health And Medical Program
- Enrolling in the Civilian Health And Medical Program
- Recertifying for Civilian Health And Medical Program
- Documentation
- Cost Sharing And Claims Processing
- Advocacy And Appeals
- Government Contacts
- Additional Resources
- Source Materials
- Child Health Plus
- COBRA Continuation Coverage
- Overview
- Description of COBRA Continuation Coverage
- Qualifying for COBRA Continuation Coverage
- Applying for COBRA Continuation Coverage
- Maintaining COBRA Continuation Coverage
- Medicaid COBRA Program
- NYS Continuation Assistance Demonstration Program for the Entertainment Industry
- Temporary Federal COBRA Subsidy
- Advocacy And Appeals
- Government Contacts
- Additional Resources
- Source Materials
- EPIC
- Family Health Plus
- Overview
- Description of Family Health Plus
- Qualifying for Family Health Plus
- Applying for Family Health Plus
- Recertifying for Family Health Plus
- Documentation
- Managed Care Provisions
- Family Health Plus Premium Assistance Program
- Family Health Plus Employer Buy-in
- Advocacy And Appeals
- Government Contacts
- Additional Resources
- Source Materials
- Healthy NY
- HIV Uninsured Care Programs
- Low Cost Health Care Options
- Overview
- Hospital Financial Assistance – Charity Care
- Health And Hospital Corporation (HHC) Options
- Prescription Assistance
- Summary
- HHC Options Prescription Assistance
- Indigent Patient Drug Programs/Prescription Assistance Programs
- AIDS Drug Assistance Program (ADAP)
- Elderly Pharmaceutical Insurance Coverage Program (EPIC)
- Medicare Part D
- NY Prescription Saver
- New York State Department of Health Prescription Drug Price Website
- Wal-Mart $4 Prescription Program
- Nord's Medication Assistance Program
- Rx Outreach
- Mail Order Pharmacies
- Community Health Centers
- Low Cost Dental Care Options
- Low Cost Vision Care Options
- Options for Self-employed
- Dependent Coverage Through Age 29
- New York Bridge Plan
- Emergency Medical Services
- Government Contacts
- Additional Resources
- Source Materials
- Medicaid
- Overview
- Description of Medicaid
- Qualifying for Medicaid
- Budgeting Income
- Applying for Medicaid
- Summary
- Applicants' Rights and Responsibilities
- Automatic Eligibility
- Presumptive Eligibility
- Pickle Eligibility
- The Medicaid Application
- Filing the Application
- Application Requirements
- Processing Time
- Notice of Acceptance/Denial
- When Benefits Begin
- Retroactive Benefits
- Authorized Representatives
- Special Populations
- Recertifying for Medicaid
- Documentation
- Cost Containment Provisions
- Medicaid Managed Care Provisions
- Medicaid Spenddown Program
- Summary
- Description of the Medicaid Spenddown Program
- Medical Bills System
- Pay-In Program
- The Medicaid Card
- In-Patient Hospital Stays
- Expenses Paid By a Public Program
- Qualifying for the Medicaid Spenddown Program
- Applying for Medicaid Spenddown
- Recertifying for Medicaid Spenddown
- Choosing Between Spenddown and Family Health Plus/Child Health Plus
- Medicaid Home Care
- Home And Community Based Waiver Services
- Summary
- Care at Home for Children with Physical Disabilities - Levels I & II
- OMH Waiver for Children and Adolescents with Serious Emotional Disturbance
- Long Term Home Health Care (LTHHC) - Lombardi Program
- Traumatic Brain Injury (TBI) Waiver Program
- Office for People with Developmental Disabilities (OPWDD) Waiver
- Bridges to Health (B2H) Waiver
- Nursing Home Transition and Diversion Waiver (NHTD)
- Institutional Medicaid
- Additional Medicaid Benefits
- Advocacy And Appeals
- Government Contacts
- Additional Resources
- Source Materials
- Medicaid Buy-In
- Medicare
- Overview
- Description of Medicare
- Qualifying for Medicare
- Enrolling in Medicare
- Documentation
- Original Medicare: Cost Sharing and Claims Processing
- Managed Care: Medicare Advantage Plans
- Medicare Supplement Plans: MEDIGAP
- Medicare And Private Health Plans
- Advocacy And Appeals
- Government Contacts
- Additional Resources
- Source Materials
- Medicare Part D
- Overview
- Description of Medicare Part D
- Qualifying for Medicare Part D
- Enrolling in Medicare Part D
- Summary
- Enrolling In/Disenrolling From a Part D Prescription Drug Plan
- Initial Enrollment Period
- Annual Coordinated Election Period
- Medicare Advantage Disenrollment Period (MADP)
- Special Enrollment Period
- Enrollment for Special Populations
- Late Enrollment Issues
- How to Choose a Drug Plan
- Notice of Acceptance
- Recertifying for Medicare Part D
- Low-income Subsidy
- Advocacy And Appeals
- Government Contacts
- Additional Resources
- Source Materials
- Medicare Savings Program
- TRICARE
- VA Health Care

