S. 506, Coordinating Care for Senior Veterans and Wounded Warriors Act

Bill Summary

S. 506 would require the Department of Veterans Affairs (VA), in consultation with the Department of Health and Human Services, to carry out a three-year pilot program to coordinate health care and benefits for veterans who are enrolled in both VA health care and Medicare. The pilot program would be conducted in up to five of VA’s regional health care networks, and each participating veteran would be assigned a case manager to coordinate care.

Estimated Federal Cost

The estimated budgetary effects of S. 506 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. 506 will be enacted near the beginning of fiscal year 2026 and that outlays will follow historical spending patterns for affected programs.

Provisions that Affect Spending Subject to Appropriation and Direct Spending

S. 506 would require VA to carry out a pilot program in up to five of its regional health care networks. The purpose of the pilot program would be to improve access to and coordination of care for veterans who are enrolled in VA health care as well as Medicare. On the basis of information from VA about the number of dual-enrolled veterans, CBO estimates that approximately 70,000 veterans would participate. Using information from VA, CBO estimates that the department would need 900 full-time equivalent positions (FTEs) to help those dual-enrolled veterans understand their benefits, assess their health care needs, and coordinate care across VA and Medicare systems. CBO estimates that salaries, benefits, and operational costs for each of those case managers would average approximately $180,000 in 2027, the first full year of the pilot program. That amount would increase annually for inflation. In total, CBO estimates that the pilot program would cost $497 million over the 2026-2035 period. Of that amount, $384 million would be spending subject to appropriation and $113 million would be direct spending.

That direct spending arises because 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 section 2 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]

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 S.506 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.506 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: Noah Callahan

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