VA MISSION Act and Community Care Providers

Military veterans present one of the most vulnerable population groups when it comes to mental health and substance abuse issues. The main reasons behind this heightened risk of developing some type of mental illness or addiction are commonly related to remarkably high stress levels they’re exposed to during military service, as well as the particularities of military culture that prevent them from recognizing and addressing these issues.1

Since 1 in 5 veterans reported abusing illicit drugs, and as many as 4 in 5 reported excessive alcohol consumption, these circumstances present a particular type of crisis, especially when paired with co-occurring mental health conditions. Yet, even though an exceptionally large number of veterans reported experiencing mental health issues (more than 3 million of them, according to SAMHSA’s national survey), less than half ended up seeking help. The deterring reasons are multiple and complex but usually involve the stigma associated with addiction and mental health issues as well as the availability of necessary treatment.2

The VA MISSION Act was passed by Congress in 2018. This act aimed to make healthcare more widely available for veterans by allowing them to receive healthcare from community care providers in clearly defined situations. The Department of Veterans Affairs (VA) was the primary source of healthcare for veterans until then, so this change was particularly significant for military veterans suffering from substance abuse and mental health issues.3

What Is The MISSION Act?

The MISSION Act was introduced to improve the existing legislation that dealt with military veterans’ healthcare and accessibility to it. Its official name is the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018, and its aim was to modernize the existing system and provide a more comprehensive selection of treatment options. In addition, the MISSION Act has amended the Veteran Community Partnership (VCP) to benefit more veterans. For example, it allows them to use community health services without requiring private health insurance.4

The VA has been working on raising awareness and encouraging veterans to reach out for help. Its healthcare division is called the Veterans Health Administration (VHA). This is the most extensive healthcare system in the US, which expanded its scope by introducing private, community care facilities into it, allowing the veterans to find appropriate care more quickly.5

This is achieved through the VCP, which includes both state and local healthcare providers, agencies, and services. It acts as a connection between the private providers in the local community and the VA. Aside from accessibility, the MISSION Act brought other significant changes, including access to higher quality medical staff and a new benefit called MISSION Act Urgent Care, available via VA’s urgent care community providers. There’s also a telehealth program called “Anywhere to Anywhere,” which provides care to veterans who live in more rural areas and can’t easily reach medical facilities.3, 4

What Is VA MISSION Act Eligibility?

Since the focus of the VA MISSION Act was to ease the delivery of healthcare services to military veterans and enable a greater amount of resources, it does so under a clearly established set of criteria that need to be met by the veterans looking for such services. Therefore, to qualify for the necessary benefits under the MISSION Act, veterans need to fulfill one of the following requirements:6

• They’ve been honorably discharged from the service.
• They have 24 months of active service (for those enlisted after September 7, 1980).
• They have one day of active-duty service (for those enlisted before September 9, 1980, or those who entered active duty on or before October 16, 1981).
• If they’re a Reservist or National Guard member and have fulfilled all their service requirements.

What Is VA Community Care?

VA Community Care is a program that allows military veterans to use a network of private, local healthcare providers in predefined cases when the VA is unable to deliver the necessary services or can’t do so within a certain period. The MISSION Act introduced community care to replace and upgrade the previously used Veterans’ Choice Program. In addition, it brought a set of more flexible rules that made suitable healthcare services more readily available.7

This is achieved through the network of community care providers. These private healthcare institutions are approved by the VA and are connected to it through the community care program. This network makes coordination between the VA and the healthcare provider simpler so that veterans and, under certain conditions, their family members can access the needed services faster. It also allows the veterans to choose their preferred healthcare providers, including primary care practitioners, specialists, home-based care, and mental health care, including substance use disorder treatment.8

VA Community Care Eligibility

The eligibility criteria for VA community care are determined on a case-to-case basis. They specify whether veterans and their dependent family members can enroll in the VA community care program and what types of benefits they can have. Aside from serving in the US military, they also consider service-related injuries, disabilities, and financial status. Each veteran’s circumstances, as well as their healthcare needs, will determine the level of benefits they’re eligible for.3

Some of the requirements are more specific and detailed, but the main ones include:3

• Both the veteran and the VA-designated clinician agree that it’s in the veteran’s best interest to receive healthcare services from a community care provider and not a VA facility.
• The VA is unable to provide the type of care the veteran needs or satisfy the quality standards determined by the VA.
• The VA can’t meet accessibility standards (waiting and driving time).
• There’s no full-service facility in the state or territory of the veteran’s residence.
• The veteran falls under the “grandfather” provision eligibility requirements, meaning they were eligible according to the criteria of the Veterans Choice Program on June 5, 2018.

What Are the Pros and Cons of the VA MISSION Act?

The main benefit of the MISSION Act implementation to US military veterans is significantly improved access to necessary healthcare services. Instead of relying exclusively on the VA and its facilities, veterans now have more options and can choose the healthcare provider they want. This allows for a broader range of high-quality specialists, facilities, diagnostics, or any other service they need. Waiting times are decreased, and modern technological solutions allow easier medical documentation sharing and scheduling appointments.6, 9

Despite all the benefits the MISSION Act has brought, there are also certain concerns that it might lead to the loss of specialized care because the VA physicians have specialized training that enables them to work with military veterans more constructively. In contrast, community care providers work with the general public and may not have all the necessary skills to deal with issues specific to veterans. Another potential drawback is the possible resources decrease due to privatization. Directing the ever-growing number of veterans to private healthcare providers may lead to reduced funding of the VA facilities, which in turn may lead to higher copayments for veterans.10

How Does MISSION Act Cover Addiction Treatment?

When it comes to substance abuse, the treatment is covered as one of the ten essential health benefits, along with mental health issues and behavioral health. This was determined by the Affordable Care Act (ACA) of 2008 and passed by Congress. The ACA requires that all health plans must cover:11

• Behavioral health treatments like counseling or psychotherapy.
• Inpatient services aimed at mental and behavioral health.
• Substance abuse treatment programs.

The MISSION Act allows the VA to broaden the scope of available services to those veterans who otherwise wouldn’t be able to access treatment at any of the VA facilities. Thanks to this new law, and the network of private community providers, each military veteran can find the right type of care for their individual circumstances.12

Under the MISSION Act, the VA can cover diverse types of substance abuse and mental health treatments. This is essential since the percentage of people suffering from co-occurring mental health illness and alcohol or drug abuse is significant, about 50%, and when it comes to veterans, the percentage is even higher. This is mainly due to the increased stress levels that military service and deployment involve and the specifics of military culture that deter a considerable number of veterans from seeking help for their mental health issues.1

Components of substance abuse treatment covered by the VA, under the provisions of the MISSION Act, include:13

• Detoxification. The first step of any substance abuse treatment. Patients are carefully monitored and given medication to mitigate unpleasant or life-threatening withdrawal symptoms. This initial phase can last anywhere from 2-3 days up to a week.
• Inpatient or residential treatment programs involve a stay at the rehab facility and can be short-term or long-term. Short-term ones usually last 28-30 days, while long-term programs, depending on the severity of addiction, last anywhere from 3-6 months to a year in most severe cases.
• Outpatient treatment and intensive outpatient treatment allow patients to live at home but come to the treatment facility each day or a few times per week, depending on the program. During the treatment at the facility, they’re provided counseling services, group therapy, support groups, or some other appropriate treatment personally tailored according to the patient’s needs.
• Partial Hospitalization Programs (PHP) are similar to outpatient ones, as they don’t require living at the treatment center. Still, they involve more time at the facility (several hours daily) and usually last at least 2-3 months. They also provide structured psychiatric services and pharmacotherapy or medication-assisted therapy if needed.

How Do I Use the VA MISSION Act?

Making the most out of the benefits that laws like the VA MISSION Act for veterans provide starts with determining your eligibility. You can do this by contacting the VA directly, using any of the online resources, or calling them. Their central information hotline is active 24/7: 800-698-2411. They can answer all your questions and direct you further.14

Generally, the subsequent steps are:12

• Being enrolled in or determining that you’re eligible for VA healthcare.
• Deciding whether you want to use the VA or community care provider services.
• Finding an appropriate community provider if that’s what you opted for.
• Getting approval from VA before scheduling an appointment with a community provider so they can send the referral and the necessary medical documentation.
• Receiving services from the community provider you chose.

How To Find VA MISSION Act Providers for Addiction Treatment?

As mentioned above, multiple VA resources are available to direct you to appropriate substance abuse treatment providers from their Approved Facilities List. In addition, the U.S. Department of Veterans Affairs website provides an easy-to-use locator tool that can help you search for rehab facilities by location and type.12

Another way to find VA approved addiction treatment centers is by contacting the American Addiction Centers (AAC). This is a nationwide network of reputable rehab facilities that offer evidence-based treatment at multiple locations across the U.S. Some of the top-rated centers that offer veteran-specific treatment programs are:

• Desert Hope in Las Vegas, Nevada. A treatment center that offers top-quality care for addiction and co-occurring disorders. Its full continuum of care includes detoxification, inpatient and outpatient services, individual and group therapy, and carefully planned aftercare programs.
• Recovery First is an alcohol and drug rehabilitation center in south Florida that offers individually tailored treatment programs and approaches to accommodate the needs of different types of patient groups. It provides a full continuum of care to all its patients after the admissions process to determine the severity of addiction and the best course of action.

You can get accurate information by calling the AAC’s hotline and talking to one of the admissions navigators. They can quickly check your insurance coverage and answer any additional questions you might have about addiction, treatment, or local detoxification facilities in your area.

Admission navigators can also explain several available insurance options for veterans. For example, they can check if you or your family members are eligible for TriWest, a commonly used insurance among military veterans. Another option is Tricare insurance for veterans and their family members.

Does the MISSION Act Provide Services to All Veterans?

The MISSION Act helps provide services to all veterans who meet the eligibility requirements. The only cases that exclude veterans from the VA coverage and don’t allow them to enroll are dishonorable discharge, bad conduct, or receiving other than honorable discharge. The most reliable way to check your options is to contact the Department of Veterans Affairs or use available resources to learn more about the VA MISSION Act.6

Eligibility criteria are easy to find on their websites or by calling the phone number cited above.

Frequently Asked Questions