The Department of Veterans Affairs (VA) will outsource hepatitis C virus (HCV) care for up to 180,000 veterans across the United States to its Choice Plan program—a controversial decision that advocates warn will severely limit the number of people who get HCV treatment and that could be illegal under federal law, the Arizona Republic reports.

The shift will essentially allow the VA to refer people living with hep C to a network of private providers enrolled with the agency, enabling them to tap into $16.3 billion in bailout money from the Veterans Access, Choice and Accountability Act. The measure was passed in 2014 with the intention of easing the backlog of veterans’ doctors appointments for those who lived too far from a VA center or who had wait times over 30 days. It remains unclear whether hep C treatment is covered under the program.

What’s more, instructions given to new panels tasked with deciding which veterans should get HCV treatment under the Choice Plan program show that only the sickest ones will get priority. Those with less than a year to live, with end-stage dementia, or those determined to have drug-resistant HCV strains, among others, will be left out.

According to recent VA emails, 200 specialists inside the agency sent a letter to Secretary Robert McDonald expressing their concern about the ethical compromises that would have to be made under the program. David Ross, MD, PhD, the VA’s director of HIV, HCV and public health pathogens programs, actually resigned from the working group tasked with implementing the plan, saying it was “unconscionable.”

Reports show that in 2014, only eight HCV-positive veterans were determined to be eligible for treatment under the outsourcing program’s criteria, while more than 16,000 got treatment through VA medical centers. The VA argues that its annual hep C budget is already nearly wiped out, and it is simply looking for options to continue providing care.

Today, it is estimated that nearly 1 in 10 U.S. veterans are living with hep C, a rate five times higher than the general population. Treatment for HCV costs between $50,000 and $100,000 per patient, even with VA discounts.