Updated January 25, 2019
Veterans Health Administration: Gender-Specific Health Care
Services for Women Veterans

Introduction
from non-VA providers.) In addition, veterans can access
Traditionally, the Veterans Health Administration (VHA)
gender-specific health care services through telehealth.
of the Department of Veterans Affairs (VA) had
Telehealth refers to a health care service that is provided via
predominantly provided gender-specific health care
a technological method. The VHA provides women’s
services to male veterans. The U.S. Census Bureau began
gender-specific telehealth services such as gynecology and
asking women about their military service in 1980 and
mental health through the VA Tele-Women’s Health
found that women veterans accounted for less than 3% of
program.
the U.S. veteran population, according to a VA report (VA,
Women Veterans Report, https://go.usa.gov/xPzNC).
Gender-Specific Health Care Services
Congress, in response to this revelation, requested
All veterans access gender-specific health care services
investigative reports from the Government Accountability
through the VA as specified in the VA medical benefits
Office on women veterans’ access to VA benefits
package. The VA medical benefits package refers to a suite
(https://go.usa.gov/xEBkM). Congress also passed a
of health care services that the VA covers and provides to
number of laws such as the Women Veterans Health
eligible veterans, generally at no cost to the veterans under
Program Act of 1992, which is Title I of the Veterans
certain circumstances. In FY2017, the VA spent $453.9
Health Care Act of 1992 (P.L. 102-585, as amended) to
million on gender-specific health care services for women
specifically increase women veterans’ access to gender-
veterans (VA, FY 2019 Funding and FY 2020 Advance
specific health care services through the VHA. The number
Appropriations: Volume II Medical Programs and
of women veterans accessing VA care is increasing. In
Information Technology Programs, p. VHA-169,
2005, for example, a total of 237,952 women veterans had
https://go.usa.gov/xPhnV). Discussed below are some
accessed VA care and that number has increased by 46.4%
gender-specific health care services that women veterans
to 455,875 women veterans receiving VA care in 2015,
can access though the VHA, unless otherwise noted. This
according to the aforementioned VA report. It is likely that
discussion is not comprehensive.
more women veterans will access VA care because the
population is projected to increase by more than half from
Primary Health Care Services
9.4% of the U.S veteran population in 2015 to 16.3% of the
Women veterans can access a range of gender-specific
U.S. veteran population by 2043.
primary health care services such as contraceptives, breast
and cervical screenings, and menopausal support services
VHA Enrollment Requirements
through the VHA, in a Women’s Health Clinic and in a
Note that the VHA enrollment requirements are the same
mixed gender primary care clinic by a designated women’s
for all veterans, whether women, men, transgender (whose
health care provider. According to the VHA Directives
gender identities are different from their sex assigned at
1341 and 1330.01(2), a transgender or intersex veteran can
birth), or intersex veterans (who are born with sexual and
access the aforementioned primary health care services
reproductive anatomies that are outside the definition of the
through the VHA, regardless of whether a change in sexual
male and female sex categories assigned at birth). The
anatomy has transpired.
Veterans’ Health Care Eligibility Reform Act of 1996 (P.L.
104-262) required the VA to establish an enrollment system
Maternity Health Care Services
that all veterans must meet in order to be eligible to receive
The VHA currently provides and pays for a limited number
VA health care services. Enrollment in the VA health care
of maternity and newborn health care services to eligible
system is based primarily on veteran status (i.e., previous
veterans and their family members. Women veterans can
military service), service-connected disability, and income.
begin accessing VA maternity care as soon as their
Veterans can apply to enroll in VA health care by mail,
pregnancies are confirmed. The VHA is different from
telephone, and in person at a VA medical facility.
other integrated health care systems because VA medical
facilities do not operate full-service birthing centers with
Access to Gender-Specific Health Care
medical units such as maternity wards, newborn nurseries,
Services
and neonatal intensive care units (NICUs). The VHA does
The VHA operates more than 1,700 VA medical facilities
not have the specialized health care providers or
where veterans can access gender-specific health care
functioning birthing-related medical units in VA medical
services. Veterans can also access these services from VA-
facilities to deliver babies on an ongoing basis. Women
contracted providers in their communities and from
veterans deliver babies at non-VA medical facilities such as
providers of the Department of Defense (DOD) at DOD
DOD medical facilities and community hospitals. The VA
medical facilities. (Note that veterans can access certain
may perform, however, emergency childbirth deliveries.
gender-specific services such as infertility treatments only
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Veterans Health Administration: Gender-Specific Health Care Services for Women Veterans
In Vitro Fertilization (IVF). The Energy and Water,
Hormone Therapy and Gender
Legislative Branch, and Military Construction and Veterans
Confirming/Affirming Surgery
Affairs Appropriations Act, 2019 (P.L. 115-929) allows the
All veterans can access hormone therapy treatments
VA Secretary, among other things, to use FY2019
through the VHA. The VA, however, does not provide or
appropriations and FY2020 advanced appropriations to
cover the costs of gender confirming/affirming surgeries.
provide certain veterans with fertility services using
assisted reproductive technology such as IVF. IVF refers to
Copayment (Copay) Requirements for
the process of combining a male’s sperm with a woman’s
VA Care
egg outside of the woman’s body, which is performed in a
VA copay requirements for VA care are the same for all
medical laboratory.
veterans. The VHA does not require veterans to pay for
their VA health care services or medications to treat a
IVF is not a standard medical benefit to all veterans. Only
service-connected disability/condition, or if the veteran
certain female and male veterans who lack the ability to
generally meets at least one of four following criteria:
naturally procreate may request IVF services, for
themselves and their spouses. Specifically, a female veteran
1. the veteran has a service-connected
must have a service-connected disability that restricts her
disability that is rated 50% or more;
eggs from being successfully fertilized by sperm. The
2. the veteran is a former prisoner of war;
female veteran must also have ovarian function and an open
3. the veteran has an annual income that is
uterine cavity. A male veteran must have a service-
below the income limit; or
connected disability that restricts the delivery of his sperm
to a woman’s egg. This benefit will cover three IVF
4. the veteran is a medal of honor recipient.
treatment cycles, which are not provided within VA
Veterans who are not exempt from paying VA copays will
medical facilities.
incur the costs of their primary care services, specialty care
services, inpatient care services, and medications
Emergency contraception. Women veterans can access
(https://go.usa.gov/xEBby). Veterans pay $15 per primary
emergency contraception from VA medical facilities on the
care visit and $50 per specialty care visit. Copays for
same day as their request for the medication.
inpatient care services range from $272 to $1,364 for the
first 90 days of care within a one-year period. Medication
Abortion. The VA medical benefits package does not
copays range from $5-$11 per 30-day or less supply of
include abortions, abortion counseling, or therapeutic
medication, $10-$22 for 31-60 days, and $15-$33 for 61-90
abortions (i.e., abortions that are performed in instances
days. The VA has capped medication copays at $700
when needed to save the life of a mother). Section 1710 of
annually.
Title 38 of the U.S. Code allows the VA Secretary to
provide therapeutic abortions as a covered benefit. The VA
Issues for Congress
Secretary through VHA Directive 1330.01(2), however, has
Women veterans pay $16 in copays per 60-day supply of
chosen to provide therapeutic abortions only to women
contraceptives. In comparison, under the Affordable Care
veterans that incur spontaneous abortions (commonly
Act (ACA: P.L. 111-148), contraceptives are a mandated
referred to as “miscarriages”).
essential benefit that requires no copay. “Unmet need” for
better information and affordable contraception for women
Newborn Health Care Services
veterans is also suggested by a recent study of 723 women
The Caregivers and Veterans Omnibus Health Services Act
veterans at risk of having unintended pregnancies. The
of 2010 (P.L. 111-163), among other things, allows the VA
findings indicated that over 38% believed that they would
Secretary to cover postdelivery health care services for
not get pregnant while having unprotected intercourse for a
eligible newborns. The VA covers newborn care that is
year (https://go.usa.gov/xEg7a). Some have argued that, as
rendered on the day of the newborn baby’s birth through the
consistent with the ACA, Congress should consider
first seven full-days of the newborn’s life.
eliminating the copay requirements for contraceptives. CRS
is not aware of any costing estimates for this proposal.
The eligibility criteria for newborn care is based on the
veteran-mother’s VHA enrollment. (Congress chose to
Congress has also shown bipartisan interest in VA newborn
exclude from this VA benefit newborns born to women
care by considering measures such as the Newborn Care
who are not veterans but have male veteran spouses.) The
Improvement Act (H.R. 907; S. 970), with the aim of
veteran-mother must meet three conditions for her newborn
extending VA newborn care beyond seven days of health
to become eligible to access care through the VHA. First,
care coverage. To date, babies born to male veterans are not
the veteran-mother must be enrolled in the VHA. Second,
authorized access to VA newborn care. Congress could
the veteran-mother must have received maternity care
choose to consider a measure that would authorize newborn
through the VHA while pregnant with the respective baby.
babies born to male veterans to have access to VA newborn
Third, the veteran-mother must have delivered the baby in
care. Both the benefits and the costs associated with such a
either a VA-contracted health care facility or VA medical
proposal would await evaluation by the VA and Congress.
facility. As noted earlier, babies generally are not delivered
in VA medical facilities. P.L. 111-163 also allows the VA
Victoria L. Elliott, Analyst in Health Policy
to cover newborn care when a newborn is abandoned or
placed for adoption by his or her veteran-mother.
IF11082
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Veterans Health Administration: Gender-Specific Health Care Services for Women Veterans


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https://crsreports.congress.gov | IF11082 · VERSION 3 · UPDATED