H.R. 1969, No Wrong Door for Veterans Act

Bill Summary

H.R. 1969 would extend the Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program administered by the Department of Veterans Affairs (VA) through fiscal year 2026 and authorize appropriations for that purpose. The bill also would clarify that VA may provide adaptive prosthetic devices for sports and recreational activities as a medical service. Finally, the bill would extend a temporary limitation on certain pension payments through January 2033.

Estimated Federal Cost

The estimated budgetary effects of H.R. 1969 are shown in Table 1. The costs of the legislation fall within budget functions 550 (health) and 700 (veterans benefits and services).

Basis of Estimate

For this estimate, CBO assumes that H.R. 1969 will be enacted in fiscal year 2025 and that outlays will follow historical spending patterns for affected programs.

Provisions that Affect Spending Subject to Appropriation and Direct Spending

Section 2 of the bill would reauthorize the Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program through fiscal year 2026 and authorize the appropriation of $53 million for that year. The program makes grants to community organizations that provide suicide prevention services to at-risk veterans.

CBO expects that some of the costs of implementing the bill would be paid from the Toxic Exposures Fund (TEF) established by Public Law 117-168, the Honoring our PACT Act. The TEF is a mandatory appropriation that VA uses to pay for health care, disability claims processing, medical research, and IT modernization that benefit veterans who were exposed to environmental hazards.

Additional spending from the TEF would occur if legislation increases the costs of similar activities that benefit veterans with such exposure. CBO estimates that 19 percent of such additional funding would come from the TEF in 2026. That percentage is based on the amount of formerly discretionary appropriations that CBO projects will be provided through the mandatory appropriation as specified in the Honoring our PACT Act.[1] CBO estimates that over the 2025-2035 period, implementing section 2 would increase spending subject to appropriation by $43 million and direct spending by $10 million.

Direct Spending

In addition to expanding benefits that would partly be covered by the TEF, CBO estimates that enacting the bill would affect direct spending by reducing pension payments to veterans and survivors who reside in Medicaid nursing homes. In total, the bill would decrease net direct spending by $46 million over the 2025‑2035 period

Under current law, VA reduces pension payments to veterans and survivors who reside in Medicaid nursing homes to $90 per month. That required reduction expires November 30, 2031. Section 4 would extend that reduction for 14 months, through January 31, 2033. CBO estimates that extending that requirement would reduce VA benefits by $10 million per month. (Those benefits are paid from mandatory appropriations and are therefore considered direct spending.) As a result of that reduction in beneficiaries’ income, Medicaid would pay more of the cost of their care, increasing spending for that program by $6 million per month. Thus, enacting section 4 would reduce net direct spending by $56 million over the 2025-2035 period.

Spending Subject to Appropriation

The discussion above in “Provisions That Affect Spending Subject to Appropriation and Direct Spending” describes the authorization of appropriations for suicide prevention grants. That authorization would increase spending subject to appropriation by $43 million over the 2025‑2035 period.

Section 3 would clarify that adaptive prostheses and terminal devices for sports and other recreational activities are included in the definition of medical services furnished to veterans. VA currently provides those types of adaptive devices; thus, CBO estimates that implementing section 3 would not affect the federal budget.

Pay-As-You-Go Considerations

The Statutory Pay-As-You-Go Act of 2010 establishes budget-reporting and enforcement procedures for legislation affecting direct spending or revenues. The net changes in outlays that are subject to those pay-as-you-go procedures are shown in Table 1.

Increase in Long-Term Net Direct Spending and Deficits

CBO estimates that enacting H.R. 1969 would not increase net direct spending or on‑budget deficits in any of the four consecutive 10-year periods beginning in 2036.

Mandates

The bill contains no intergovernmental or private-sector mandates as defined in the Unfunded Mandates Reform Act.

Estimate Prepared By

Federal Costs:

Noah Callahan (for veterans health care) 
Logan Smith (for pensions)

Mandates: Brandon Lever

Estimate Reviewed By

David Newman
Chief, Defense, International Affairs, and Veterans’ Affairs Cost Estimates Unit

Kathleen FitzGerald 
Chief, Public and Private Mandates Unit

Christina Hawley Anthony
Deputy Director of Budget Analysis

Estimate Approved By