VA Benefits, the MISSION Act, and Community Care
Do VA Benefits Cover Mental Health and Co-Occurring Disorders?
Yes. Mental health is a significant challenge for many Veterans. What you experience in conflict zones and combat is unlike anything a civilian will face. This can lead to mental health and substance use struggles. The VA will provide coverage to help Vets seek care for these struggles.
Expansion of Treatment Options in the Community
The VA has also made strides to expand care outside of the VA. In 2018, the Department of Veterans Affairs launched the MISSION Act, followed by the Veterans Community Care Program in 2019, to improve and expand health care benefits for Veterans and their caregivers.
The initiatives were designed to make accessing physical and psychological health care faster and easier for all Veterans, within both the VA health care system and in community care settings.2
Oxford Treatment Center is an authorized community care provider (CCP) in the VA’s community care network and out-of-network provider for Tricare East. Unsure about your coverage?
What if I Have VA Healthcare and Other Health Insurance?
Some Veterans have other health coverage alongside their VA benefits. Whether that’s TRICARE, Medicare, Medicaid, or a private insurance plan, you can use your VA benefits along with your other insurance coverage.4
If you have a service-related illness or disorder, for example, and a non service-related issue that co-occur, you can stack your benefits and the VA will bill your other health insurance for any non service-related care.4
When your private insurer pays for part or all of your non-service-connected needs, the funds may offset your VA copayment.4
You do not have to have additional insurance coverage, but there are some benefits. For example, the VA does not typically provide benefits for family members, so additional insurance may be used to cover the care your family members need.4
How Do I Get Addiction Treatment with VA Benefits?
If you need help with substance use disorder, your VA benefits will provide important coverage for you. If you haven’t applied for VA health care, that’s the first step.5
The VA has effective, evidence-based programs and services for alcohol and substance use disorders, and for problems related to substance use, which can range from unhealthy alcohol use to compulsive addictive behaviors that have become life-threatening.6
Once you’ve signed up, talk to your VA care provider about your addiction and your needs. Your provider can schedule screenings for substance use problems along with co-occurring issues such as PTSD or anxiety.
Once the screening is completed, other VA health care providers can discuss the options for addiction treatment in the VA, which include:6
- Medically managed detoxification to safely manage withdrawal, including monitoring after detox to ensure medical stability.
- Inpatient residential (live-in) care.
- Continuing care after detox and residential treatment to prevent relapse.
- Intensive outpatient treatment.
- Short-term outpatient counseling with a focus on motivation.
- Marriage and family counseling.
- Self-help groups.
If you don’t currently have a VA care provider, contact your local VA center. You can also call VA’s general information number at 800-827-1000. They can help you schedule an in-person or virtual appointment to get the help you need.7
Finding Community Care Outside of the VA with the MISSION Act
The VA is generally your first stop for healthcare, but the VA cannot always accommodate your needs. The MISSION Act expanded the VA’s ability to work with private providers, including Oxford Treatment Center, to give you more options near where you live or to accommodate you if you cannot be treated at a VA facility.
An online search tool allows Veterans or caregivers to locate nearby substance use disorder programs, both in VA facilities and through community care providers that are in the VA network.
What Is the MISSION Act?
The MISSION Act was designed to improve access to healthcare for Veterans, both within the VA healthcare system and in the community, and to expand benefits for Veterans’ caregivers.2
Veterans made more than 58 million appointments for VA care in the last fiscal year.8 This means that there may be long wait times for openings in VA alcohol or substance use treatment programs.
This is why the MISSION Act and community care providers initiatives were implemented—to broaden the network of community care providers and speed access to treatment, including treatment for addiction and other mental health disorders, for all Veterans.2
Community Care Eligibility
The Veterans Community Care Program replaced the Veterans Choice Program (VCP) in June of 2019.9 Veterans who were eligible for community care under the VCP may be “grandfathered” into the Veterans Community Care Program if eligibility was based on distance from a VA medical facility. 10
Veterans whose eligibility was not based on distance, or those previously not eligible for community care, are encouraged to discuss the new requirements and what they might mean for them.
The new eligibility criteria cover 6 possible situations in which a Veteran may receive a referral to treatment from a community care provider. Only 1 of the 6 criteria needs to be met to qualify. However, the Veteran must already be enrolled in or be eligible for on-site VA health care before they can qualify for community-based care.10
Eligibility criteria include the following situations:10
- Service is unavailable at the VA—examples include maternity care and in-vitro fertilization.
- Facility is unavailable—there is no full-service VA medical facility in the state or US territory of residence.
- Grandfathered in—the Veteran met eligibility for community care on distance criteria under the Veterans Choice Program.
- Best medical interest of the Veteran—referral to a community provider was determined by a VA health care provider to be in the Veteran’s best medical interest.
- Quality standards are not met—the VA’s medical service cannot provide care meeting the VA’s quality standards.
- Access standards are not met—average drive time or wait time for an appointment is longer than the VA’s acceptable standards.
How to Use a Community Care Provider for Substance Use Disorder Treatment
The VA healthcare system is ready to work with Veterans and caregivers to arrange access to needed treatment from community care providers, a situation that may be especially important to Veterans struggling with addiction who have been on waitlists for an opening in high-demand VA drug or alcohol treatment programs.
The Community Care Quick Start Guide describes the process for receiving care under the Veterans Community Care Program, from determining eligibility to referrals and scheduling, to receiving treatment, and finally to payment/billing.
VA resources are available for Veterans and caregivers to access online to get more information on many of these topics. Some relevant resources include:
- A general overview of the MISSION Act and the Veterans Community Care Program.
- The online search tool to find community care providers.
- A fact sheet on appointments and getting care.
- A fact sheet on billing and payment.
- Details on applying for financial hardship assistance for community care treatment.
Oxford’s Salute to Recovery Program
Oxford Treatment Center offers an addiction treatment program specifically for Veterans with substance or alcohol use disorders. The program, Salute to Recovery, was designed to address the unique challenges of former military service members—based on an understanding of the ways that military experiences, mental health, and addiction are related.
Salute to Recovery treatment programs help Veterans learn that addiction is a disease, not a weakness, and give them coping skills to maintain sobriety after treatment is completed.
Oxford Treatment Center is an authorized Community Care Provider (CCP) in the VA’s community care network. You can access a community care provider under a variety of circumstances, such as when a service isn’t available at the VA, the program is full, or it’s deemed in the best medical interest of the Veteran.11