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The Automobile Assistance Program The Veterans Benefits Administration administers the Automobiles and Adaptive Equipment for Certain Disabled Veterans and Members of the Armed Forces program,24 which offers a one-time payment of not more than $11,000 toward the purchase of an automobile or other vehicle. VA pays for adaptive equipment and for repair, replacement, or reinstallation required because of disability. A veteran may qualify for automobile assistance for this VA benefit if he or she has: A service connected loss or permanent loss of use of one or both hands or feet; or A permanent impairment of vision of both eyes to a certain degree; or Entitlement to compensation for ankylosis (immobility) of one or both knees or one of both hips.25 VA TRANSPORTATION EXPENDITURES In 2003, the Government Accountability Office (GAO; then known as the General Accounting Office) reported FY 2001 expenditures for transportation of disadvantaged persons by the VA of $126,594,591 through the Veterans Medical Care Benefits program and $33,639,000 through the Autos and Adaptive Equipment for Certain Disabled Veterans Program.26 According to an unpublished report from CTAA, the Department of Veterans Affairs spent $170 million in FY 2004 to reimburse veterans for travel to and from VA facilities to receive medical care.27 ". . . the VA is committed to providing services to veterans meeting certain eligibility criteria. This service, called "Beneficiary Travel", is funded through the Veterans Health Administration (VHA) as part of the medical care budget and is contained in the budget line item "Miscellaneous Benefits and Services". The funding is separate from the Veteran's Benefits Administration (VBA) that funds disability compensation and pension benefits. 24 The authorization for this program is found in Title 38 Unites States Code Chapter 39; implementing regulations are found in Title 38 CFR 17.155 17.159. 25 Department of Veterans Affairs. (no dates). "VA Health Care Eligibility and Enrollment: Special and Limited Benefits" http://www4.va.gov/healtheligibility/coveredservices/SpecialBenefits.asp#Auto, accessed May 5, 2010. 26 United States General Accounting Office, Transportation Disadvantaged Populations: Some Coordination Efforts Among Programs Providing Transportation Services, but Obstacles Persist, Washington, DC, June 2003, GAO-03-697. 27 John Lasfargues, "Evaluation of Existing Capacity and Unmet Need for Medical Transportation with the Veteran Population," draft report prepared for the Community Transportation Association of America, Washington, DC, March 2005, p. 1. 24

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However, eligibility for medical care benefits is determined by a complex rating system that is administered by VBA."28 VA provides funds for travel to approved medical services related to health conditions and travel for compensation and pension eligibility examinations. (The next section provides more precise details concerning eligibility for these services.) "The transportation that is provided for veterans is either provided through a contract with an outside source or left to the veteran to arrange and then be reimbursed. The program is administered at the local level and left to the individual hospital network to determine how this service will be provided. In all cases except in cases of medical emergency, the veteran must receive authorization from his attending physician stating that the treatment or service is medically necessary."29 From 2005 to 2010, VHA's transportation expenses increased dramatically. VHA Beneficiary Travel expenses for FY 2009 were $629 million, which was a 69 percent increase over the FY 2008 figure of $373 million. In FY 2010, costs increased to $745 million. (Note that these figures do not include expenses for VBA's Automobile Assistance program.) This rapid cost increase stems from an increased number of veterans claiming travel reimbursement, increased numbers of claims per veteran, and the congressionally mandated changes in travel reimbursement costs and decreased deductible requirements. For many years, the beneficiary travel mileage reimbursement rate that veterans could claim for eligible trips for medical and other approved trips was 11 cents per mile. That rate was changed to 28.5 cents per mile effective February 1, 2008; VA's Secretary raised the beneficiary travel reimbursement rate to 41.5 cents per mile on November 17, 2008. VA's December 2009 report to Congress reported that "Since the November 2008 rate change, VA has experienced [an] approximate increase of 76 percent in the number of mileage claims, and [a] 30 percent increase in the number of veterans claiming travel reimbursements."30 This new level of expenditure makes VHA's Beneficiary Travel program one of the most highly funded transportation programs for persons with special needs. As shown in Table 2, VHA's expenses exceed all but the two largest transportation programs for individuals with special travel needs: Medicaid and Head Start. 28 Ibid. 29 Ibid, p. 3. 30Department of Veterans Affairs, "Report to Congress: PL 110-387, Section 401: Veterans Beneficiary Travel Program," December, 2009. 25