VA Healthcare Benefits, the MISSION Act & Community Care
If you’re a Veteran struggling with addiction and/or co-occurring mental illness, you may be wondering if your VA benefits will cover treatment. The short answer is yes, your VA healthcare will cover addiction treatment in some capacity. Veterans can also stack VA benefits with additional health insurance coverage. Lastly, the VA helps Vets access treatment by allowing eligible veterans to seek treatment with community providers.
Does VA Healthcare Cover Mental Health and Co-Occurring Disorders?
VA benefits provide a breadth of mental health coverage, including coverage for substance abuse and mental health disorders. VA benefits often include coverage for the following:1
- Inpatient and residential care.
- Outpatient mental health care.
- Programs for substance use disorders.
- Psychosocial and recovery support services.
- Evidence-based therapy.
- PTSD treatment.
How Can I Get Addiction Treatment Using VA Benefits?
If you or a loved one is seeking treatment for substance abuse, mental health, or co-occurring disorders, you may be wondering how to do so with your VA benefits. In the vast majority of cases, you will need to apply for VA healthcare prior to receiving coverage for addiction treatment under VA benefits. Click here to apply for VA healthcare.
Once you’ve applied for care, your next steps will depend on whether you have a VA primary care provider or not. If so, you’ll want to talk to them about your substance use or abuse and/or other mental health disorders.2 Your VA provider will then conduct a health screening, help you determine the best course of treatment, and book your treatment.2
If you haven’t been to a VA center, clinic or hospital, or haven’t seen a VA primary care provider, don’t worry, you can still obtain treatment through your VA benefits. To do so, you’ll need to do one of the following:2
- Call the VA’s information hotline (800-827-1000).
- Contact your local VA center.
- Find a VA facility near you.
What if I Have VA Healthcare and Another Health Insurance Plan?
If you have a health insurance plan (e.g., a private plan, Medicare, Medicaid, or TRICARE) and VA benefits, you can use them together. In many cases, VA benefits will only cover treatment for military service-related illnesses or disorders, and your secondary insurance plan will provide coverage for treatment not covered under your VA benefits.3
What Is Community Care?
Community care is a VA program that allows Veterans to seek out treatment from non-VA providers for a variety of health issues, including substance abuse and co-occurring disorders such as PTSD.
While the VA hospitals and clinics are generally considered to be the foundation of healthcare for Veterans, they aren’t the only options. In some cases, VA hospitals or clinics may be at capacity or otherwise unable to provide treatment and have to outsource care for mental illness, co-occurring disorders, substance use disorders, or addiction to non-VA healthcare facilities through their community care program.4
How the MISSION Act Changed VA Community Care
In recent years, the VA experienced a significant increase in the use of VA health services. For example, Veterans made 58 million appointments with VA facilities in 2018, an increase of 3.4 million from 2014.7 Improved access to community health services and providers helps the VA meet this increased demand and helps Veterans get the treatment they need in a timely manner.
The MISSION Act of 2018 helps the U.S. Department of Veterans Affairs (VA) expand caregiver benefits, improve Veteran access to both community and VA healthcare facilities, and “recruit and retain the best medical providers.”5 By expanding access to community care, the MISSION Act seeks to ensure America’s Veterans receive the highest-quality care in convenient locations.6
With the implementation of the MISSION Act, the VA took steps to improve the treatment experience for Veterans through a number of initiatives:8,9
- Title I of the Act enfolds previous community care programs into a single new entity called the Veterans Community Care program.
- Among other things, Title I also outlines payment procedures, establishes education and training programs, defines safe opioid prescribing practices, and expands the VA’s family care programs.
- Title II mandates a much-needed infrastructure review process.
- To improve the recruitment of healthcare professionals, Title III offers such incentives as scholarships and hiring bonuses.
- Title IV seeks to expand healthcare in underserved areas through telehealth services (accessing healthcare over the phone or computer) and mobile health clinics.
Updated Community Care Eligibility & Benefits
In its effort to consolidate and expand community care options for Veterans, the MISSION Act phased out the Veteran’s Choice Program (VCP).10 The VA grandfathered VCP enrollees into the distance criteria for the new Community Care Program. Among the key differences from the VCP, the Community Care Program:11
- Streamlines eligibility criteria and makes it easier for Veterans to understand whether they qualify to use community care.
- Simplifies the program and reduces the risk for errors by relying on a single set of processes and rules.
- Improves customer service through new education and communication resources.
- Establishes a new urgent care benefit allowing Veterans access to a network of walk-in care providers for non-emergent care.
VA Community Care Network Providers
Like the VCP, the Veterans Community Care program provides various telehealth services while simultaneously offering veterans the option to continue using VA facilities.6 The program also allows VA benefits to cover access to non-VA providers if they provide services that the VA cannot. To streamline this interchange of providers, the program improves information-sharing between VA facilities and community care providers.5
These community care providers form a new Community Care Network (CCN) administered by third-party administrators (TPAs). This system allows the VA, and sometimes the veteran directly, to arrange outside providers while requiring TPAs to make timely payments.11 Among other services, community providers include medical practitioners, substance abuse rehabilitation centers, therapists, and pharmacies.12
In many ways, the MISSION Act makes it easier for Veterans to find and access treatment outside of the traditional route of visiting a VA facility, as long as they are deemed eligible to receive community care.
How Can I Search for Community Care?
Veterans and VA staff work together to find the appropriate provider, taking the Veteran’s preference into account as much as possible. If a preferred provider is not part of the CCN, the VA may be able to add them to the network.4
The VA provides a facility locator tool that allows Veterans to search for a provider by location, facility, and service type.12 For example, a Veteran in east Tennessee can search for the specific type of care (e.g., “substance abuse rehabilitation center”), the type of provider preferred (community care or VA), and the zip code to narrow down options nearby.
VA Community Care Eligibility: What to Know
The first step toward accessing a community care provider is to get enrolled in VA healthcare.5,14 Once enrolled, if Veterans meet any one of the 6 following VA community care eligibility criteria, they can go to a CCP.15
- The Veteran needs a service not offered by a VA medical facility.
- A Veteran lives in a state or territory without a full-service VA medical facility.
- Veterans qualify under the VCP grandfather provisions.
- The VA cannot provide the Veteran services within certain designated access standards (such as long travel distances or excessive appointment wait times).
- Community care better serves the Veteran’s medical needs.
- A particular VA service line fails to meet certain quality standards.
It is important to note that community care first requires the VA approval and that this care is “dependent upon a Veteran’s individual health needs or circumstances.”15 Veterans always retain the right to choose VA facilities instead of community care.
Community Care Through Desert Hope
Desert Hope has worked with the VA to become a certified community care provider. This means if you or someone you love is seeking addiction treatment for Veterans, Desert Hope Treatment Center in Las Vegas, NV, is an option for you.
Desert Hope provides a unique program called Salute to Recovery that aims to meet the unique needs of Veterans and first responders. Several staff members are Veterans themselves and provide a supportive and understanding perspective on the recovery needs of each patient in the program.
Desert Hope’s treatment program for Veterans combines drug and alcohol addiction treatment with care for other co-occurring mental health disorders. This integrated approach is especially important for Veterans who often struggle with mental health issues such as post-traumatic stress disorder (PTSD), anxiety, and depression.”13
Along with a comprehensive curriculum, the program offers a variety of treatment methods that include:
- Cognitive-behavioral therapy.
- Anger management training.
- 12-Step support group meetings.
- Learning coping skills.
- Family and couples counseling.
- Developing conflict resolution methods.
- Individual and group treatment.
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