GAO-03-904R DOD and VA Health Care for Dual Eligibles 

United States General Accounting Office 

Washington, DC 20548 

June 13, 2003 

The Honorable John Warner 

Chairman 

The Honorable Carl Levin 

Ranking Minority Member 

Committee on Armed Services 

United States Senate 

The Honorable Duncan Hunter 

Chairman 

The Honorable Ike Skelton 

Ranking Minority Member 

Committee on Armed Services 

House of Representatives 

Subject: DOD and VA Health Care: Access for Dual Eligible Beneficiaries

The Department of Defense (DOD) reported that under its current policy, 

beneficiaries eligible for both TRICARE and the Department of Veterans Affairs’ (VA) 

health care (dual eligible beneficiaries) are not allowed to utilize the services offered 

by both health care systems for treatment for the same episode of care.1

 For 

example, if a beneficiary experiences back pain and seeks treatment from VA, the 

beneficiary must then receive all care related to that back pain from VA. Should the 

beneficiary then decide to seek treatment for the back pain from TRICARE, any 

claims related to that care would be denied. According to DOD, this policy was 

established to ensure continuity of care for beneficiaries and to ensure that there was 

no duplication of care or of payments from TRICARE or VA. Under the policy, if 

beneficiaries are dissatisfied with the care provided by VA, they are unable to switch 

to TRICARE to receive services for the same episode of care. 

Section 708 of the Bob Stump National Defense Authorization Act for Fiscal Year 

20032

 directed the Secretary of Defense to establish a process for resolving issues 

related to patient safety and continuity of care for beneficiaries who are concurrently 

eligible for health care through DOD’s TRICARE program and through VA. It also 

 

1

According to DOD, an episode of care is generally accepted to be all care related to a single injury or 

illness. 

2

Pub. L. No. 107-314, § 708, 116 Stat. 2458, 2585 (2002). 
2 GAO-03-904R DOD and VA Health Care for Dual Eligibles 

required that the Comptroller General review and report on issues related to dual 

eligibility. 

On April 16, 2003, DOD reported3

 to the Congress on a proposal to change its policy 

and promulgate regulations for coordinating care between DOD and VA. As agreed, 

we focused our review on the reasonableness of DOD’s process. To do so, we 

reviewed the report submitted to the Congress and TRICARE policies, and 

interviewed agency officials from DOD and VA. Our work was conducted in June 

2003 in accordance with generally accepted government auditing standards. 

DOD proposes to change its basic policy to enable dual eligible beneficiaries to 

access both systems for the same episode of care, thus ensuring full freedom of 

choice. DOD also proposes to pay for medically necessary care to the extent that 

such care would be covered by TRICARE. DOD’s proposal appears reasonable, and it 

is in the process of developing regulations to implement it. 

An official with the TRICARE Management Activity reviewed a draft of this letter and 

agreed the information in it is correct. We are sending copies of this letter to the 

Secretary of Defense, appropriate congressional committees, and other interested 

parties. We will provide copies of it to others upon request. In addition, it is 

available at no charge on the GAO Web site at http://www.gao.gov. If you or your 

staff have any questions, please contact me at (202) 512-7101 or Michael T. Blair, Jr., 

at (404) 679-1944. 

Cynthia A. Bascetta 

Director, Health Care—Veterans’ 

 Health and Benefits Issues 

(290272) 

 

3

Report to Congress: Department of Defense Plan for Coordinating Care Between TRICARE and the 

Department of Veterans Affairs (Washington, D.C.: April 2003). 
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