Audit of VHA's Homeless Providers Grant and Per Diem Case Management Oversight

The VA Office of Inspector General conducted this audit to determine if the Veterans Health Administration’s (VHA) Grant and Per Diem (GPD) Program case management oversight ensures services to eligible veterans are provided in accordance with grant agreements. We found VHA’s oversight of homeless providers’ case management helped to ensure services were provided in accordance with grant agreements for those veterans in the Program. However, eligibility requirements need to be clarified so all homeless veterans have equal access to case management services. We found 15 of 130 VA medical facilities (12 percent) within 6 different Veterans Integrated Service Networks required veterans to be eligible for VA health care to participate in the GPD Program. GPD policy only requires an individual to have served in the active military, naval, or air service, and been discharged or released under conditions other than dishonorable. The VHA Handbook and US Code provide minimum active duty requirements to be eligible for VA health care benefits. VHA has been silent on addressing this additional eligibility requirement in its current policy. VHA has not aggressively pursued an Office of General Counsel formal opinion and confusion at all program levels regarding eligibility requirements has resulted in inequitable access to case management services. In addition, we observed medication security issues at 5 of 22 providers (23 percent) we visited within 5 of the 6 medical facilities in our sample. This occurred because VHA and program providers did not ensure controls were sufficient to properly secure medications. As a result, veterans’ health and rehabilitation are potentially at risk.