Veterans Health Administration: Gender-Specific Health Care Services for Women Veterans




Updated February 6, 2020
Veterans Health Administration: Gender-Specific Health Care
Services for Women Veterans

Introduction
them reported a reduction in fear from transitioning out of
Traditionally, the Veterans Health Administration (VHA)
the military. The 116th Congress is considering a number of
of the Department of Veterans Affairs (VA) had
measures on this program, including the Servicewomen’s
predominantly provided gender-specific health care
Health Transitioning Act of 2019 (H.R. 2941; S. 2324) and
services to male veterans. The U.S. Census Bureau began
Helping Expand and Launch Transitional Health for
asking women about their military service in 1980 and
Women Veterans Act (H.R. 2942; S. 3182). These two sets
found that women veterans accounted for less than 3% of
of companion bills would, if enacted, among other things,
the U.S. veteran population, according to a VA report (VA,
require the VA and DOD Secretaries to submit a report to
Women Veterans Report, https://go.usa.gov/xPzNC).
specified congressional committees on program outcomes.
Congress, in response to this revelation, requested
investigative reports from the Government Accountability
VHA Enrollment Requirements
Office on women veterans’ access to VA benefits
The VHA enrollment requirements are the same for all
(https://go.usa.gov/xEBkM). Congress also passed a
veterans, whether women, men, transgender (whose gender
number of laws such as the Women Veterans Health
identities are different from their sex assigned at birth), or
Program Act of 1992, which is Title I of the Veterans
intersex veterans (who are born with sexual and
Health Care Act of 1992 (P.L. 102-585, as amended) to
reproductive anatomies that are outside the definition of the
specifically increase women veterans’ access to gender-
male and female sex categories assigned at birth). The
specific health care services through the VHA.
Veterans’ Health Care Eligibility Reform Act of 1996 (P.L.
104-262) required the VA to establish an enrollment system
The number of women veterans accessing VA care is
that all veterans must meet in order to be eligible to receive
increasing. In 2014, for example, 423,642 women veterans
VA health care services. Enrollment in the VA health care
had accessed VA care, and that number has increased by
system is based primarily on veteran status (i.e., previous
22.1% to 517,241 women veterans receiving VA care in
military service), service-connected disability, and income.
2018, according to the VA’s budget report FY 2020
Veterans can apply to enroll in VA health care by mail,
Funding and FY 2021 Advance Appropriations: Volume II
telephone, and in person at a VA medical facility.
Medical Programs and Information Technology Programs
(p. VHA-156, https://go.usa.gov/xdDRn). It is likely that
Access to Gender-Specific Health Care
more women veterans will access VA care because the
Services
population is projected to increase by more than half from
The VHA operates more than 1,700 VA medical facilities
9.4% of the U.S veteran population in 2015 to 16.3% of the
where veterans can access gender-specific health care
U.S. veteran population by 2043.
services. Veterans can also access these services from VA-
contracted providers in their communities and from DOD
Transitioning to VA Care
providers at DOD medical facilities. (Veterans can access
The VA and the Department of Defense (DOD) jointly
certain gender-specific services such as infertility
administer the Women’s Health Transitioning Training
treatments only from non-VA providers.) In addition,
Program, which aims to prepare servicewomen and women
veterans can access gender-specific health care services
veterans for VHA enrollment. The free training is delivered
through telehealth. Telehealth refers to a health care service
in-person and virtually. During the interactive training
that is provided via a technological method. The VHA
sessions, servicewomen and women veterans receive
provides women’s gender-specific telehealth services such
information on, but not limited to, the
as gynecology and mental health through the VA Tele-
Women’s Health program.
 process of becoming a service-connected veteran,

Gender-Specific Health Care Services
differences in the delivery of health care services
All veterans access gender-specific health care services
between VA and DOD medical facilities,
through the VA as specified in the VA medical benefits
 various types of women’s health care services that can
package. The VA medical benefits package refers to a suite
be accessed through the VA, and
of health care services that the VA covers and provides to

eligible veterans, generally at no cost to the veterans under
available support for other concerns, such as
certain circumstances. In FY2017, the VA spent $5.6
homelessness.
billion on health care services for women veterans,
according to the aforementioned VA funding report.
From July 2018 to May 2019, the program administrators
Discussed below are some gender-specific health care
surveyed an initial 383 participants and found that 88% of
services that women veterans can access though the VHA,
https://crsreports.congress.gov

Veterans Health Administration: Gender-Specific Health Care Services for Women Veterans
unless otherwise noted. This discussion is not
facilities and community hospitals. The VA may perform,
comprehensive.
however, emergency childbirth deliveries.
Primary Health Care Services
In Vitro Fertilization (IVF). The Military Construction,
Women veterans can access a range of gender-specific
Veterans Affairs, and Related Agencies Appropriations Act,
primary health care services such as contraceptives, breast
2020, which is Division F of the Further Consolidated
and cervical screenings, and menopausal support services
Appropriations Act (P.L. 116-94), allows the VA Secretary
through the VHA, in a Women’s Health Clinic and in a
to, among other things, use funds appropriated to the
mixed gender primary care clinic by a designated women’s
“Medical Services” account to, among other things, provide
health care provider. According to the VHA Directives
certain veterans with fertility services using assisted
1341 and 1330.01(2), a transgender or intersex veteran can
reproductive technology such as in vitro fertilization (IVF).
access the aforementioned primary health care services
IVF refers to the process of combining a male’s sperm with
through the VHA, regardless of whether a change in sexual
a woman’s egg outside of the woman’s body, which is
anatomy has transpired.
performed in a medical laboratory.
Intimate Partner Violence (IPV) Services
IVF is not a standard medical benefit to all veterans. Only
IPV is a subset of domestic violence, which in this context,
certain female and male veterans who lack the ability to
involves a veteran’s experience of reoccurring violent
naturally procreate may request IVF services, for
physical, sexual, and psychological behaviors performed by
themselves and their spouses. Specifically, a female veteran
a current or former intimate partner. All veterans and their
must have a service-connected disability that restricts her
intimate partners can access IPV services through the VA’s
eggs from being successfully fertilized by sperm. The
IPV Assistance Program (IPVAP), which was established in
female veteran must also have ovarian function and an open
2014. IVAP consists of a suite of integrated VA and non-
uterine cavity. A male veteran must have a service-
VA prevention, intervention, treatment, and support
connected disability that restricts the delivery of his sperm
services. According to the aforementioned VA funding
to a woman’s egg. This benefit will cover three IVF
report, more than 145 VA medical facilities have
treatment cycles, which are not provided within VA
implemented IPVAPs. Each of those facilities has an
medical facilities.
IPVAP Coordinator who is responsible for identifying,
screening, assessing, and coordinating IPV related services.
Emergency contraception. Women veterans can access
emergency contraception from VA medical facilities.
Military Sexual Trauma (MST) Services
MST refers to physical sexual assault or sexual harassment
Abortion. The VA medical benefits package does not
occurring during military service that causes psychological
include abortions, abortion counseling, or therapeutic
trauma. P.L. 102-585 and subsequent laws require, among
abortions.
other things, the VA Secretary to administer an MST
program whereby veterans can access counseling and
Newborn Health Care Services
medical and support services. The VA Military Sexual
The Caregivers and Veterans Omnibus Health Services Act
Trauma (MST) Program is available to all veterans,
of 2010 (P.L. 111-163), among other things, allows the VA
regardless of a veteran’s eligibility status for VA care and
Secretary to cover postdelivery health care services for
service connection. A veteran does not have to disclose the
eligible newborns. The VA covers newborn care that is
details of his or her MST experience to a VA provider in
rendered on the day of the newborn baby’s birth through the
order to access MST services. There are no out-of-pocket
first seven full-days of the newborn’s life.
costs associated with MST care. In addition, the VA does
not require veterans’ respective secondary health insurance
The eligibility criteria for newborn care is based on the
plans to cover the costs of any MST-related health care
veteran-mother’s VHA enrollment. (Congress chose to
services. Each VA medical facility has an MST Coordinator
exclude from this VA benefit newborns born to women
who is responsible for VA outreach and coordination of
who are not veterans but have male veteran spouses.) The
MST care.
veteran-mother must meet three conditions for her newborn
to become eligible to access care through the VHA. First,
Maternity Health Care Services
the veteran-mother must be enrolled in the VHA. Second,
The VHA currently provides and pays for a limited number
the veteran-mother must have received maternity care
of maternity and newborn health care services to eligible
through the VHA while pregnant with the respective baby.
veterans and their family members. Women veterans can
Third, the veteran-mother must have delivered the baby in
begin accessing VA maternity care as soon as their
either a VA-contracted health care facility or VA medical
pregnancies are confirmed. The VHA is different from
facility. As noted earlier, babies generally are not delivered
other integrated health care systems because VA medical
in VA medical facilities. P.L. 111-163 also allows the VA
facilities do not operate full-service birthing centers with
to cover newborn care when a newborn is abandoned or
medical units such as maternity wards, newborn nurseries,
placed for adoption by his or her veteran-mother.
and neonatal intensive care units. The VHA does not have
the specialized health care providers or functioning
Victoria L. Elliott, Analyst in Health Policy
birthing-related medical units in VA medical facilities to
deliver babies on an ongoing basis. Women veterans deliver
IF11082
babies at non-VA medical facilities such as DOD medical
https://crsreports.congress.gov

Veterans Health Administration: Gender-Specific Health Care Services for Women Veterans


Disclaimer
This document was prepared by the Congressional Research Service (CRS). CRS serves as nonpartisan shared staff to
congressional committees and Members of Congress. It operates solely at the behest of and under the direction of Congress.
Information in a CRS Report should not be relied upon for purposes other than public understanding of information that has
been provided by CRS to Members of Congress in connection with CRS’s institutional role. CRS Reports, as a work of the
United States Government, are not subject to copyright protection in the United States. Any CRS Report may be
reproduced and distributed in its entirety without permission from CRS. However, as a CRS Report may include
copyrighted images or material from a third party, you may need to obtain the permission of the copyright holder if you
wish to copy or otherwise use copyrighted material.

https://crsreports.congress.gov | IF11082 · VERSION 4 · UPDATED