VA’s Dole Act Implementation Lags

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The Department of Veterans Affairs remains stalwart in their commitment to implementing the Elizabeth Dole 21st Century Veterans healthcare Benefits Improvement Act, but has been stymied by staff loss and lack of funding.

On March 4, 2026, the House Veterans' Affairs Subcommittee on Oversight and Investigations held a hearing on the progress of the Department of Veterans Affairs' (VA) implementation of provisions of the Elizabeth Dole 21st Century Veterans Healthcare Benefits Improvement Act, signed into law in 2025.

The law was designed to modernize the Department of Veterans Affairs and systemically improve veterans' access to health care and home and community based services. LeadingAge remains supportive of the legislation, including a pilot for VA to pay for assisted living for veterans, availability of PACE to veterans through VA contracting, and expansion of community care benefit limits.

During the hearing, subcommittee members heard from Dr. Thomas O'Toole, acting assistant VA undersecretary for health for clinical services in the Veterans Health Administration, who reported that the VA has successfully implemented 25 of the 72 sections in the Dole Act. Shannon Silas, director of healthcare in the Government Accountability Office (GAO), reported that the VA has yet to complete actions laid out in prior GAO reports, findings, and recommendations. Dr. O'Toole was joined by other members of the VA administration and defended efforts to implement provisions from the Dole Act while reiterating that the law provided limited new funding for policy and program development.

The law's prime sponsor, Congressman Juan Ciscomani (AZ-6), noted that subcommittee members on both sides of the aisle are "running a little impatient on the implementation on a lot of these programs…" Bipartisan criticism of the VA's efforts centered on inadequate staffing, poor communication with veterans, and slow implementation of the law.

LeadingAge met with staff from the VA responsible for implementing PACE and the assisted living pilot for veterans on March 3. Much work has been done to operationalize access to both services for vets. The assisted living pilot is likely to roll out in two separate Veterans Integrated Services Networks (VISNs), with one program located within a state Veteran's Home, and the second contracting with an existing assisted living provider. The availability of the PACE program through the VA is getting closer. PACE organizations interested in contracting to provide services to veterans should begin conversations with local VA medical centers to educate social work staff on the format, benefits, and participant satisfaction of PACE programs to support referrals once VA central office has cleared the remaining administrative hurdles. Staff at the VA reiterated the VA's commitment and focus on these services and said more information on both programs would be available soon.