This report focuses on FY2018 appropriations and FY2019 advance appropriations for the Department of Veterans Affairs (VA). Generally, the VA is funded through the Military Construction, Veterans Affairs, and Related Agencies (MILCON-VA) Appropriations Act. This report begins by providing a brief overview of the VA. Then it describes the VA budget and advance appropriations. Although not part of annual appropriations, the report also discusses recent funding developments regarding the Veterans Choice Program (VCP), as that program plays an integral role in the delivery of health care to veterans through private community providers. The report then describes the President's budget request for FY2018 appropriations and advance appropriations for FY2019, along with congressional action. The report provides funding levels for the accounts as passed by the House and recommended by the Senate Appropriations Committee; it does not provide funding levels at the subaccount, program, or activity levels. The history of the present-day Department of Veterans Affairs (VA) can be traced back to July 21, 1930, when President Hoover issued Executive Order 5398, creating an independent federal agency known as the Veterans Administration by consolidating many separate veterans programs. On October 25, 1988, President Reagan signed legislation ( P.L. 100-527 ) creating a new federal cabinet-level Department of Veterans Affairs to replace the Veterans Administration, effective March 15, 1989. The VA provides a range of benefits and services to veterans and eligible dependents who meet certain criteria as authorized by law. These benefits include medical care, disability compensation and pensions, education, vocational rehabilitation and employment services, assistance to homeless veterans, home loan guarantees, administration of life insurance and traumatic injury protection insurance for servicemembers, and death benefits that cover burial expenses. The VA carries out its programs nationwide through three administrations and the Board of Veterans Appeals (BVA). The Veterans Benefits Administration (VBA) is responsible for, among other things, providing compensation, pensions, education assistance, and vocational rehabilitation and employment services. The National Cemetery Administration (NCA) is responsible for maintaining national veterans cemeteries; providing grants to states for establishing, expanding, or improving state veterans cemeteries; and providing headstones and markers for the graves of eligible persons, among other things. The Veterans Health Administration (VHA) is responsible for providing health care and social support services to eligible veterans; conducting medical and prosthetic research; training health care professionals; serving as a contingency backup to the Department of Defense (DOD) medical system during a national security emergency; and providing support to the National Disaster Medical System and the Department of Health and Human Services (HHS), as necessary. The VHA is primarily a direct service provider of primary care, specialized care, and related medical services to veterans through the nation's largest integrated health care system. When needed, VHA pays for veterans' care delivered in the private sector (care in the community). Inpatient and outpatient care are also provided in the private sector to eligible dependents of veterans under the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA). The VA budget includes both mandatory and discretionary funding. Mandatory accounts fund disability compensation for veterans, the survivor's Dependency and Indemnity Compensation (DIC) program, pensions, vocational rehabilitation and employment, education, life insurance, housing, clothing allowances, and burial benefits (such as burial allowances, grave liners, outer burial receptacles, and headstones and markers), among other benefits and services. Discretionary accounts fund medical care, medical research, construction programs, information technology, the Office of Inspector General, BVA, and general operating expenses, among other things. These accounts are further supplemented by revolving funds, such as the Canteen Service Revolving Fund and the Pershing Hall Revolving Fund; trust funds, such as the Department of Veterans Affairs Cemetery Gift Fund and the General Post Fund; and special funds, such as the Medical Care Collections Fund; and the Capital Asset Fund. Figure 1 shows a breakdown of the FY2017-enacted amounts for major programs by mandatory and discretionary spending. Approximately 58% of VA's annual appropriations for FY2017 funded mandatory veterans benefits, and approximately 37% funded health care programs. In 2009, Congress enacted the Veterans Health Care Budget Reform and Transparency Act of 2009 ( P.L. 111-81 ), authorizing advance appropriations for three of the four VHA accounts: medical services, medical support and compliance, and medical facilities. In 2014, Congress passed the Consolidated and Further Continuing Appropriations Act, 2015 ( H.R. 83 ; P.L. 113-235 ), which amended 38 U.S.C §117 and included three more accounts to the advance appropriations list of accounts. This act authorizes advance appropriations for three mandatory VA benefits programs within the Veterans Benefits Administration: compensation and pensions, readjustment benefits, and veterans insurance and indemnities. Beginning with the FY2016 Military Construction and Veterans Affairs, and Related Agencies Appropriations Act (MILCON- VA; P.L. 114-113 ), those accounts received advance appropriations for the first time in FY2017, in addition to the three VHA accounts already authorized to receive advance appropriations. Section 4003 of the Surface Transportation and Veterans Health Care Choice Improvement Act of 2015 ( P.L. 114-41 ) required the establishment of a separate new account for medical community care, beginning with the FY2017 appropriations cycle. The Jeff Miller and Richard Blumenthal Veterans Health Care and Benefits Improvement Act of 2016 ( P.L. 114-315 ) authorized advanced appropriations for the medical community care account. The FY2017 MILCON-VA Act (Division A of P.L. 114-223 ) funded the FY2017 requirements for the new medical community care account by rescinding from the 2017 advance appropriation amounts in the medical services account enacted in the Consolidated Appropriations Act, 2016 ( P.L. 114-113 ), and reappropriating those funds. The act also provides advance appropriations for FY2018 to the new medical community care account. Congress has authorized ( P.L. 111-81 ; P.L. 113-235 ; and P.L. 114-315 ) advance appropriations of new budget authority for these VBA and VHA accounts to prevent potential delays in the delivery of care and benefits to veterans that may arise in the event of a funding lapse. Under present budget scoring guidelines, advance appropriations are scored as new budget authority in the fiscal year in which they become available for obligation, not in the fiscal year the appropriations are enacted and required to be accommodated within the statutory spending caps for that year. Therefore, throughout the funding tables in this report, advance appropriations numbers are shown under the label "memorandum" and in the corresponding fiscal year column. For example, FY2018 advance appropriations provided in the Continuing Appropriations and Military Construction, Veterans Affairs, and Related Agencies Appropriations Act, 2017, and Zika Response and Preparedness Act ( P.L. 114-223 ) are not shown under the FY2017 column but appear in the FY2018 column under the label "memorandum." Similarly, FY2019 advance appropriations provided in the House-passed FY2018 MILCON-VA bill (Division K of H.R. 3354 —Make America Secure and Prosperous Appropriations Act, 2018) and the Senate-reported FY2018 MILCON-VA bill ( S. 1557 ; S.Rept. 115-130 ) are not shown in the FY2018 column but appear in the FY2019 column under the label "memorandum." In response to the crisis of access to medical care at many VA hospitals and clinics across the country reported in 2014, Congress passed the Veterans Access, Choice, and Accountability Act of 2014 ( P.L. 113-146 , as amended by P.L. 113-175 , P.L. 113-235 , P.L. 114-19 , P.L. 114-41 , and P.L. 115-26 ). On August 7, 2014, President Obama signed the bill into law. The act, as amended, makes a number of changes to programs and policies of the VHA that aim to increase access and lower wait times for veterans who seek care at VA facilities. Among other things, the act established a new program (the Veterans Choice Program) to allow the VA to authorize care for veterans outside the VA health care system if they meet certain criteria. The act also provided mandatory funding for the Veterans Choice Program (VCP), by establishing the Veterans Choice Fund (Section 802 (a) of P.L. 113-146 as amended) and appropriating a total of $10 billion over three years. The original sunset date for the VCP was August 7, 2017. In addition, Section 801(a) of the Choice Act ( P.L. 113-146 ; 38 U.S.C. §1701 note) provided an additional mandatory funding of $5 billion to increase veterans' access to health care by hiring more physicians and staff, and to improve VA's capital infrastructure and support information technology (IT) infrastructure. These Section 801(a) funds would remain available until expended. Two subsequent laws have affected the duration of the VCP, as well as the availability and amount of the appropriations in the Veterans Choice Fund. First, it was estimated around January 2017 that not all the funds in the Veterans Choice Fund would be exhausted by August 7, 2017. In response, on April 19, 2017, President Trump signed into law P.L. 115-26 (an act to amend the Veterans Access, Choice, and Accountability Act of 2014 to modify the termination date for the Veterans Choice Program, and for other purposes; unofficially known as the as the Veterans Choice Program Improvement Act).