S. 827, Supporting Rural Veterans Access to Healthcare Services Act

Bill Summary

S. 827 would make Native American tribes, tribal organizations, Native Hawaiian organizations, and county veteran service agencies eligible to receive Department of Veterans Affairs (VA) grants to provide transportation to veterans in highly rural areas. The bill also would authorize VA to provide grants to organizations that provide such transportation to purchase vehicles that meet the requirements of the Americans with Disabilities Act (ADA). Finally, the bill would increase the maximum amount for transportation grants to organizations that serve communities that are not connected to the local road network.

Estimated Federal Cost

The estimated budgetary effects of S. 827 are shown in Table 1. The costs of the legislation fall within budget function 700 (veterans benefits and services).

Basis of Estimate

For this estimate, CBO assumes that S. 827 will be enacted near the start of fiscal year 2026 and that outlays will follow historical spending patterns for similar VA programs.

Background

VA is authorized to provide grants to organizations that transport veterans between their homes and VA medical facilities. Under current law, only veteran service organizations recognized by VA and state veteran service agencies that operate in highly rural counties (those counties with fewer than seven people per square mile) are eligible for grants. The maximum grant amount is limited to $50,000 per year, and VA regulations limit the grants to one per county. Based on data from VA, CBO estimates that almost 450 counties meet the definition of highly rural, and 210 of those counties have organizations that receive grants from VA under the program. The department currently spends about $9 million annually on the program.

Provisions that Affect Spending Subject to Appropriation and Direct Spending

S. 827 would make several changes to VA’s grant program for organizations that provide transportation to veterans in highly rural areas. CBO estimates those changes would increase the cost of the program by about $7 million per year once the changes are phased in, and by about $60 million in total over the 2026-2035 period.

First, S. 827 would make Native American tribes, tribal organizations, Native Hawaiian organizations, and county veteran service agencies eligible for grants under the program. Based on information from VA, CBO estimates those changes would expand transportation coverage to an additional 100 counties. CBO expects new recipients would receive grants close to the maximum amount of $50,000 per county; thus, the provision would cost $5 million per year. Costs would be less in the first few years because of the time needed to inform newly eligible organizations and to process grant applications.

In addition, S. 827 would authorize VA to provide organizations that receive transportation grants with additional grants of $80,000 per county to purchase ADA-compliant vehicles. Based on a review of available literature, CBO estimates grantees would require new vehicles every 10 years. Using that information, CBO projected that each year about 10 percent of the 310 counties with transportation service (the 210 existing counties plus the estimated 100 new counties) would receive a vehicle grant, for a total cost of about $2 million per year.

Further, S. 827 would authorize an additional grant of $25,000 per year to organizations that serve counties with five or more communities that are not connected to the local road network. Based on data from the State of Alaska, CBO estimates those additional grants would go to five organizations in Alaska, at a cost of $1 million over the 2025-2035 period.

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. Thus, in addition to increasing spending subject to appropriation, enacting S. 827 would increase amounts paid from the TEF, which are classified as direct spending. CBO projects that the proportion of costs paid by the TEF will grow over time based on the amount of formerly discretionary appropriations that CBO expects 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 S. 827 would increase spending subject to appropriation by $44 million and direct spending by $16 million.

Uncertainty

Two factors could cause costs to be more or less than is estimated here. The number of newly eligible organizations that would apply for and receive transportation grants could differ from CBO’s estimate. Also, the number of grants to purchase vehicles could vary based on VA rulemaking on how often organizations request those additional grants.

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 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 S. 827 would not increase net direct spending by more than $2.5 billion in any of the four consecutive 10-year periods beginning in 2036.

CBO estimates that enacting S. 827 would not increase on‑budget deficits by more than $5 billion 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: Matt Schmit

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