H.R. 7158 – Long-Term Care Veterans Choice Act

AI-Generated Summary

Updated February 8, 2026 at 10:10 AM UTC

The Long‑Term Care Veterans Choice Act lets the Department of Veterans Affairs contract with non‑VA medical foster homes to pay for long‑term care for veterans who cannot live independently. It creates a five‑year pilot allowing up to an average of 900 veterans per day to receive such care at federal expense, and requires veterans to accept VA‑provided home health services. The law also establishes monitoring, reporting to Congress, and periodic audits, and makes a minor change to a housing loan fee date.

Key Provisions

VA may place eligible veterans in approved medical foster homes and pay for their care, both for new placements and for veterans already in such homes, during a five‑year period.
The program is limited to an average of 900 veterans per day nationwide.
Veterans receiving VA‑paid care must agree to receive home health services from the VA.
The VA must track requests, denials, participating homes, and veterans receiving care, and report findings to Congress.
The Comptroller General must submit implementation and impact reports at three and six years after enactment.
The date in the VA housing loan fee table is changed from January 14, 2031 to February 15, 2031.

Legislative Activity

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11 earlier actions

SenateIntro Referral Latest Action

Received in the Senate and Read twice and referred to the Committee on Veterans' Affairs.

Veterans' Affairs Committee

December 5, 2022

View full timeline

HouseIntro Referral

Introduced in House

March 18, 2022

HouseIntro Referral

Referred to the House Committee on Veterans' Affairs.

Veterans' Affairs Committee

March 18, 2022

HouseCommittee

Committee Consideration and Mark-up Session Held.

Veterans' Affairs Committee

April 6, 2022

HouseCommittee

Ordered to be Reported by Voice Vote.

Veterans' Affairs Committee

April 6, 2022

HouseFloor

Mr. Takano moved to suspend the rules and pass the bill, as amended.

November 29, 2022 • 2:44 PM

HouseFloor

Considered under suspension of the rules. (consideration: CR H8607-8609; text: CR H8607-8608)

November 29, 2022 • 2:44 PM

HouseFloor

DEBATE - The House proceeded with forty minutes of debate on H.R. 7158.

November 29, 2022 • 2:44 PM

HouseFloor

At the conclusion of debate, the Yeas and Nays were demanded and ordered. Pursuant to the provisions of clause 8, rule XX, the Chair announced that further proceedings on the motion would be postponed.

November 29, 2022 • 2:54 PM

HouseFloor

Pursuant to the provisions of H. Res. 1499, proceedings on H.R. 7158 are considered vacated.

December 1, 2022 • 5:10 PM

HouseFloor

Passed/agreed to in House: Pursuant to section 5 of H. Res. 1499, and the motion offered by Mr. Hoyer, the following bills passed under suspension of the rules: H.R. 4601, as amended; H.R. 4772, as amended; H.R. 4899; H.R. 5943, as amended; H.R. 7158, as amended; H.R. 8203; H.R. 9308; and S. 3825; and the following resolutions were agreed to under suspension of the rules: H. Res. 744, as amended; and H. Res. 922, as amended.(consideration: CR H8696-8700; text: CR H8697-8698)

December 1, 2022 • 5:10 PM

HouseFloor

Pursuant to section 5 of H. Res. 1499, and the motion offered by Mr. Hoyer, the following bills passed under suspension of the rules: H.R. 4601, as amended; H.R. 4772, as amended; H.R. 4899; H.R. 5943, as amended; H.R. 7158, as amended; H.R. 8203; H.R. 9308; and S. 3825; and the following resolutions were agreed to under suspension of the rules: H. Res. 744, as amended; and H. Res. 922, as amended. (consideration: CR H8696-8700; text: CR H8697-8698)

December 1, 2022 • 5:10 PM

SenateIntro Referral

Received in the Senate and Read twice and referred to the Committee on Veterans' Affairs.

Veterans' Affairs Committee

December 5, 2022

Floor Debate

7 members

What members said about H.R. 7158 on the floor

+2

4 Republicans3 Democrats

Rep. Mark TakanoD-CA-41 · Nov 29, 2022

Mr. Speaker, I move to suspend the rules and pass the bill (H.R. 7158) to amend title 38, United States Code, to authorize the Secretary of Veterans Affairs to enter into contracts and agreements for…

Mr. Speaker, I move to suspend the rules and pass the bill (H.R. 7158) to amend title 38, United States Code, to authorize the Secretary of Veterans Affairs to enter into contracts and agreements for the payment of care in non-Department of Veterans Affairs medical foster homes for certain veterans who are unable to live independently, and for other purposes, as amended.

Mr. Speaker, I ask unanimous consent that all Members may have 5 legislative days in which to revise and extend their remarks and include extraneous material on H.R. 7158, as amended.

Mr. Speaker, I yield myself such time as I may consume.

Mr. Speaker, I rise in support of H.R. 7158, as amended, the Long- Term Care Veterans Choice Act.

This bill, authored and long championed by Congressman Higgins and Chairwoman Brownley, would enable VA to better provide long-term services and support for our aging and disabled veterans.

The VA's medical foster homes are one of its most creative and effective initiatives. Veterans who have access to these care settings thrive and are able to remain a part of their community, even if their conditions do not allow them to remain independently in their homes.

Veterans who are not yet ready for institutional care but need the help and assistance of professional caregivers are able to live in a home setting among other veterans in their communities. Satisfaction with the program is very high, but veterans have to pay for the care themselves, which is a barrier for many veterans. Yet, VA is currently prohibited from paying a veteran's room and board. This legislation would change that.

Community-based programs like these are what veterans want and deserve. They also prevent veterans from being forced into much more expensive institutional care settings.

Mr. Speaker, I wholeheartedly support this bill, and I encourage all of my colleagues to join me in supporting this legislation.

Mr. Speaker, I reserve the balance of my time.

Mr. Speaker, I appreciate the ranking member's desire to engage in talks regarding the toxic exposure fund. It is an important issue, which is the long-term implications of the Cost of War Toxic Exposures Fund, otherwise known as TEV, and it was created by the Honoring our PACT Act.

This fund is absolutely crucial to ensuring VA has the resources necessary to fully support our veterans and to deliver the new benefits available to them without having to sacrifice existing programs.

As I have said repeatedly, any potential change to this fund and how it operates must be considered very carefully and requires the input of other committees that have a stake in this issue, to include appropriations and budget in the House and Senate.

Mr. Speaker, I reserve the balance of my time.

Mr. Speaker, I thank the gentleman from Louisiana for his hard work. I feel his sincere words. I take them to heart, and I sincerely hope that we get this through the Senate so that we can see this signed into law before the end of this year.

Mr. Speaker, I have no further speakers, and I am prepared to close.

Mr. Speaker, I reserve the balance of my time.

Mr. Speaker, as I have said before on the floor of this House, serving our veterans is not about red or blue. It is about red, white, and blue. I know that the ranking member stands with me in service of our veterans, and he stands with me right now in the optimism that Team USA is going to prevail today at the World Cup. They are ahead 1-0. I know the ranking member and I, and the gentleman from Louisiana, are all standing united with the hope of an American victory there.

Mr. Speaker, again, I ask all my colleagues to join me in passing

Rep. Sheila Jackson LeeD-TX-18 · Dec 5, 2022

Mr. Speaker, I rise in support of H.R. 7158, the Long-Term Care Veterans Choice Act, to authorize the Secretary of Veterans Affairs to enter into contracts and agreements for the payment of care in…

Mr. Speaker, I rise in support of H.R. 7158, the Long-Term Care Veterans Choice Act, to authorize the Secretary of Veterans Affairs to enter into contracts and agreements for the payment of care in non-Department of Veterans Affairs medical foster homes for certain veterans who are unable to live independently.

Medical foster homes are private homes where a trained caregiver provides services to a few individuals. These facilities serve as an alternative to nursing homes, providing residents with the comfort of home with medical attention readily available.

Medical foster homes and caregivers must meet specific criteria to ensure that veterans receive the same level of care that would be provided in traditional Veterans Affairs facilities or nursing homes.

Caregivers must demonstrate the ability to provide care and supervision 24/7, communicate significant changes in a veteran's status, and have caregiving experience, along with other requirements.

The home where a veteran would be living must go through inspection with a VA multidisciplinary team, provide a home-like environment, meet National Fire Protection Association (NFPA) Life Safety Code, and more.

The medical foster care program started in 2008 and has served over 1,000 veterans nationally. According to the Department of Veterans Affairs, the demand for medical foster homes is highest in rural areas, where veterans want to stay in the communities in which they are comfortable.

The Department of Veterans Affairs says that the home environment enriches the lives of veterans and their caregivers. Veterans who live in this type of setting tend to have fewer hospitalizations than those in institutional care or who live alone.

This program is providing our nation's veterans with a sense of belonging and community while also providing them with the medical care they need. Many veterans that are in medical foster homes report feeling like they are part of a family and supported.

It is estimated that there are 46,000 veterans in nursing homes across the country. Nursing homes do provide patients with the medical attention they need, but many patients miss the aspect of living in their community, in a home, and with family.

This bill would provide veterans from my home of Houston, Texas with the option to stay in their communities and be part of a family while receiving 24/7 care. Instead of stripping these veterans from their communities this bill will provide them with a way to be better engrained in their communities.

The Long-Term Care Veterans Choice Act would provide veterans who want to be at home with the ability to seek care that provides that level of support and familiarity.

I urge my colleagues to join me in support of H.R. 7158, Long-Term Care Veterans Choice Act. With the passage of this bill, we can give a sense of family back to many veterans who have been longing for a sense of normalcy.

Rep. Mike BostR-IL-12 · Nov 29, 2022

Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, I rise today in support of H.R. 7158, the Long-Term Care Veterans Choice Act. H.R. 7158 would give VA the authority to grant…

Mr. Speaker, I yield myself such time as I may consume.

Mr. Speaker, I rise today in support of H.R. 7158, the Long-Term Care Veterans Choice Act.

H.R. 7158 would give VA the authority to grant payments to non-VA entities for veterans who require long-term care in medical foster homes. A medical foster home is a private home, not an institutional facility, where trained caregivers provide wraparound care and service to patients.

VA inspects and approves medical foster homes and enrolls veterans in the VA Home Healthcare Program. But under current law, VA is not authorized to pay for veterans' medical foster home care. Veterans must cover the bill themselves, even if they would otherwise be eligible for a VA-run nursing home facility.

Now, medical foster homes are a more cost-effective alternative to nursing home care. They typically cost between $1,500 and $3,000 a month, compared to a typical $7,000-a-month cost in a nursing home.

Allowing veterans to age with dignity and being comfortable is something that I care deeply about, and this bill is a critical step towards helping us to do just that.

However, this is another bill that CBO gave a large mandatory score to because of the toxic exposure fund. We were able to fully offset this score, but we won't be able to do that for every piece of legislation. Our offsets are quickly running out, and we have to solve the scoring problem before the work of our committee grinds to a complete halt.

This bill is supported by the VA and numerous VSOs, and I thank Congressman Higgins for his tireless work on it.

Mr. Speaker, I ask all of my colleagues to support H.R. 7158, and I reserve the balance of my time.

Mr. Speaker, I look forward to working with the chairman as we move forward to try to cure that problem that we were just talking about.

Mr. Speaker, I yield 3 minutes to the gentleman from Louisiana (Mr. Higgins), a great Member, who has worked hard on this bill.

Mr. Speaker, I encourage all of my colleagues to support this bill, and I yield back the balance of my time.

Rep. Clay HigginsR-LA-3 · Nov 29, 2022

Mr. Speaker, I rise in support of the Long- Term Care Veterans Choice Act. The Department of Veterans Affairs has been running its medical foster homes initiative since the year 2000, and as of 2021,…

Rep. Steny H. HoyerD-MD-5 · Dec 1, 2022

Madam Speaker, pursuant to section 5 of House Resolution 1499, I move to suspend the rules and pass the bills: H.R. 4601, H.R. 4772, H.R. 5943, H.R. 7158, and agree to H. Res. 744 and H. Res. 922.

Show 2 more

Rep. Matthew M. Rosendale, Sr.R-MT · Dec 1, 2022

Madam Speaker, on that I demand the yeas and nays.

Rep. Bob GoodR-VA-5 · Nov 29, 2022

Mr. Speaker, on that I demand the yeas and nays.

Bill Text

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Referred in SenateIssued December 5, 2022

IIB

117th CONGRESS

2d Session

H. R. 7158

IN THE SENATE OF THE UNITED STATES

December 5, 2022

Received; read twice and referred to the Committee on Veterans' Affairs

AN ACT

To amend title 38, United States Code, to authorize the Secretary of Veterans Affairs to enter into contracts and agreements for the payment of care in non-Department of Veterans Affairs medical foster homes for certain veterans who are unable to live independently, and for other purposes.

1.

Short title

This Act may be cited as the Long-Term Care Veterans Choice Act.

2.

Secretary of Veterans Affairs contract authority for payment of care for veterans in non-Department of Veterans Affairs medical foster homes

(a)

Authority

(1)

In general

Section 1720 of title 38, United States Code, is amended by adding at the end the following new subsection:

(h)

(1)

During the five-year period beginning on the date of the enactment of the Long-Term Care Veterans Choice Act, and subject to paragraph (3)—

(A)

at the request of a veteran for whom the Secretary is required to provide nursing home care under section 1710A of this title, the Secretary may place the veteran in a medical foster home that meets Department standards, at the expense of the United States, pursuant to a contract, agreement, or other arrangement entered into between the Secretary and the medical foster home for such purpose; and

(B)

the Secretary may pay for care of a veteran placed in a medical foster home before such date of enactment, if the home meets Department standards, pursuant to a contract, agreement, or other arrangement entered into between the Secretary and the medical foster home for such purpose.

(2)

A veteran on whose behalf the Secretary pays for care in a medical foster home under paragraph (1) shall agree, as a condition of such payment, to accept home health services furnished by the Secretary under section 1717 of this title.

(3)

In any year, not more than a daily average of 900 veterans receiving care in a medical foster home, whether placed before, on, or after the date of the enactment of the Long-Term Care Veterans Choice Act, may have their care covered at the expense of the United States under paragraph (1).

(4)

The prohibition under section 1730(b)(3) of this title shall not apply to a veteran whose care is covered at the expense of the United States under paragraph (1).

(5)

In this subsection, the term medical foster home means a home designed to provide non-institutional, long-term, supportive care for veterans who are unable to live independently and prefer a family setting.

.

(2)

Effective date

Subsection (h) of section 1720 of title 38, United States Code, as added by paragraph (1), shall take effect 90 days after the date of the enactment of this Act.

(b)

Ongoing Monitoring of Medical Foster Home Program

(1)

In general

The Secretary of Veterans Affairs shall create a system to monitor and assess the workload for the Department of Veterans Affairs in carrying out the authority under section 1720(h) of title 38, United States Code, as added by subsection (a)(1), including by tracking—

(A)

requests by veterans to be placed in a medical foster home under such section;

(B)

denials of such requests, including the reasons for such denials;

(C)

the total number of medical foster homes applying to participate under such section, disaggregated by those approved and those denied approval by the Department to participate;

(D)

veterans receiving care at a medical foster home at the expense of the United States; and

(E)

veterans receiving care at a medical foster home at their own expense.

(2)

Report

Based on the monitoring and assessments conducted under paragraph (1), the Secretary shall identify and submit to Congress a report on such modifications to implementing section 1720(h) of title 38, United States Code, as added by subsection (a)(1), as the Secretary considers necessary to ensure the authority under such section is functioning as intended and care is provided to veterans under such section as intended.

(3)

Medical foster home defined

In this subsection, the term medical foster home has the meaning given that term in section 1720(h) of title 38, United States Code, as added by subsection (a)(1).

(c)

Comptroller General Report

Not later than each of three years and six years after the date of the enactment of this Act, the Comptroller General of the United States shall submit to Congress a report—

(1)

assessing the implementation of this section and the amendments made by this section;

(2)

assessing the impact of the monitoring and modifications under subsection (b) on care provided under section 1720(h) of title 38, United States Code, as added by subsection (a)(1); and

(3)

setting forth recommendations for improvements to the implementation of such section, as the Comptroller General considers appropriate.

(d)

Modification of certain housing loan fee

The loan fee table in section 3729(b)(2) of title 38, United States Code, is amended by striking January 14, 2031 each place it appears and inserting February 15, 2031.

3.

Determination of budgetary effects

The budgetary effects of this Act, for the purpose of complying with the Statutory Pay-As-You-Go Act of 2010, shall be determined by reference to the latest statement titled Budgetary Effects of PAYGO Legislation for this Act, submitted for printing in the Congressional Record by the Chairman of the House Budget Committee, provided that such statement has been submitted prior to the vote on passage.

Passed the House of Representatives December 1, 2022.

Cheryl L. Johnson,

Clerk.