VA Choice Program: Drug and Alcohol Rehab Centers

What is a Veteran choice program? How can it help veterans recover from drug and alcohol addiction? What are the different plans and coverage?

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Substance use presents a major challenge among the US army veteran population. Substance abuse disorders (SUD) have a number of negative effects on veteran’s mental and physical health, which also influences their social and economic standing.1

Although the Department of Veterans Affairs (VA) and other agencies make considerable efforts to put the substance use rates under control, the numbers of veterans abusing various substances continue to rise. SUDs among veterans are correlated with many medical issues, mental diseases like depression and anxiety, vocational and interpersonal disability, and greater likelihood of suicidal thoughts and behavior.1

Heavy occasional drinking and cigarette smoking presents the most prevalent type of substance abuse patterns among veterans of any sex. Nevertheless, as in the non-veteran population, male veterans are much more likely to be diagnosed with an SUD. Approximately 10.5% of male Veterans struggle with alcohol use in comparison with 4.8% female Veterans. By the same token, 4.8% male Veterans abuse illicit drugs, which is also true for 2.4% female Veterans.1

Besides the mental health issues that may occur as a result of SUD, mental illness can also serve as a trigger for the onset of substance abuse. These can be a consequence of environmental stress, interpersonal traumas, PTSD or depression.1

There is a clear need for a comprehensive approach to the issue, which would elevate stigma, lift barriers, and ensure that veterans recover from SUD and reintegrate into the civilian population. Access to effective and affordable services that will address the health needs of veterans is paramount to keeping them, their families, and neighbors safe.1,2

What is Veterans Choice Insurance?

The Veterans Choice Program was a set of temporary benefits that enabled eligible veterans to receive necessary medical attention in their residing communities. It has since been replaced by the Veterans Community Care Program. This program eliminates the need to travel to a distant VA facility and minimizes the waiting time it takes to make an appointment with the VA department.2

When the necessary care cannot be provided through VA, veterans can count on support from community providers. Community care programs are tailored to meet individual eligibility requirements, availability of VA care, and the unique circumstances and needs of affected Veterans. The VA Choice Program can include a wide array of options, from substance abuse screening regimens, outpatient counseling, to relapse prevention, detoxification and managed care:2

Does Veterans Choice Program Offer Coverage For Drug and Alcohol Rehab?

Veterans Choice has provided for a full scope of treatment for veterans seeking to cease with alcohol abuse or to recover from debilitating addiction. The services can usually be adjusted to your specific requirements, in order to ensure optimal results and a streamlined recovery. 2,3

However, whether the VA choice coverage will suffice to cover the sum of the costs for a particular rehab facility or type of treatment is a valid question for your VA office. Veterans struggling with SUD and related conditions are therefore advised to check with their local healthcare provider and their VA office to check their insurance.2,3

Which Types of Addiction Treatment Veterans Choice Program May Cover?

Veterans Choice Program has rendered proven medical options in battling substance abuse and addiction. As a continuation of VCP, Veterans Community Care insurance will typically cover the following: 2,3

  • Substance replacement therapies and implementation of prescription drugs that reduce cravings toward addictive substances, for example methadone or buprenorphine therapies. 
  • Medical substitution for nicotine and other treatments that can help deter tobacco use and nicotine addiction

Will My VA Choice Program Cover Mental Health Treatment?

Veterans who struggle with substance abuse often face other difficulties, including underlying mental health issues. These conditions can be triggered or worsened by substance abuse. By the same token, these underlying mental health issues can exacerbate the symptoms of SUD. In the Veteran population, the most frequent diagnoses include:5

  • Posttraumatic stress disorder (PTSD)
  • Depression
  • Bipolar disorder
  • Anxiety disorders, such as panic disorder and generalized anxiety disorder.

For this reason, apart from the medical aspect of the addiction treatment, your VA choice program is also likely to cover a variety of psychological counseling and therapy options. If you are struggling with a dual diagnosis, your insurance might cover:3,4,5

    • Short-term counseling in an outpatient setting
  • Counseling for married couples and families
  • Self-help groups
    • Partial hospitalization options
    • Intensive outpatient therapy programs (IOPs)
  • Comprehensive care in a live-in setting
  • Long-term care with the aim of preventing substance abuse relapse
  • Programs specialized for specific Veteran groups, such as female Veterans, Veterans returning from the combat zone, and Veterans that struggle with homelessness).

The VA Choice program also offers coverage for dual diagnosis treatment. For example, if you struggle with depression and SUD, post-combat PTSD or a general anxiety disorder and substance abuse, etc.

Which States Accept Veterans Choice Insurance?

If you are a Veteran and you need urgent medical care in the local community, as of June 9, 2019, you can enter selected civilian urgent care facilities on a national level. This is a result of an extension of the VA’s Mission Act, itself an extended package of the Veterans Choice Act. In other words, it will allow eligible veterans to seek medical attention from selected civilian doctor.6,7

Many veterans have other forms of health care insurance, for example Medicaid, Medicare, TRICARE, or a private health insurance plan. In this case, you will be able to use your Veterans Choice Insurance along with these other plans.7

In Massachusetts, VA Choice operates as a brand of Medicaid. Therefore, veterans living in Greater Boston, Cape Cod, Bristol, Plymouth, Suffolk, Essex, Norfolk Counties and beyond, can rely on their Medicaid and Veterans Choice insurance packages.7

Who Qualifies for VCP (Veterans Choice)?

Veterans that aim to use VCP are required to meet certain eligibility criteria. This involves receiving an approval from VA to receive care in the local community, as well as being enrolled in the healthcare program of the VA department after 1st of August 2014. Additionally, the eligibility for VA Choice is also determined by one of the following points:2,8

  • Your local VA office was unable to set an appointment within the 30-day timeframe, i.e. from the day clinically determined by your selected physician.2
  • The driving distance between your home and the nearest VA department staffed with a full time primary care physician exceeds 40 miles.2
  • Your nearest VA facility is not accessible by road, so you are expected to reach it by plane, ferry, or boat.2
  • Your travel to the nearest VA poses a toll to your physical or mental wellbeing due to unique environmental, geographical, or medical issues.2
  • There is no full service VA office in the state or US territory in which you require an emergency medical help, hospital care, surgery or similar services, or there are no similar facilities like this within 20 miles of your home. For example, in case of SUD, you had to ask for a detoxification in a civilian facility. Please note: This last criterion is applicable to Veterans that reside in the following states and territories:2,3
    • Alaska
    • Hawaii
    • New Hampshire
    • Guam
    • American Samoa
    • Commonwealth of the Northern Mariana Islands
    • U.S. Virgin Islands
    • Some Veterans in New Hampshire reside within 20 miles of White River Junction VAMC, yet they also qualify.

How to Make a Claim Through the Veterans Choice Program for My Rehab Treatment?

When you need to file a VA Choice insurance claim, the process is usually straightforward. What is worth noting as a Veteran struggling with substance abuse, VA no longer needs permission to bill your health insurance provider for care aimed at a sensitive diagnosis. The list includes drug abuse and addiction, alcohol abuse, HIV or HIV testing, sickle cell anemia, and similar diagnoses.7

What are My Options If Rehab Costs Are Not Fully Covered?

Eligible veterans don’t have to pay any unpaid balance not covered by the health insurance provider. However, depending on the assigned priority group, non-service-connected care might have to be co-paid from your own pocket.7

Another option would be to reduce your costs by opting for a more narrow or short-term treatment plan. However, keep in mind that long-term treatment is positively correlated to greater chances at recovery.8

What are Veterans Choice Program Coverage Levels and Plans?

The Veteran Choice Program i.e. the Veterans Community Care Program has various plans and levels of eligibility. Eligibility is split into different priority groups. The levels of priority are determined by the veteran’s army service history, the overall disability rating, their income level, their Medicaid qualifications, and the availability of other potential benefits, for example VA retirement benefits.

The Veterans with service-connected disabilities are assigned the highest priority. In comparison, the lowest priority is assigned to veterans with high income without any service-connected disabilities that qualify them for monthly payments. In case of SUDs, veterans that have developed a disability due to their substance abuse are more likely to be on the priority list.

How Can I Check My Veterans Choice Program Rehab Coverage?

Before you strike a decision and pick the facility, it is best to call your selected healthcare provider and check the preferred rehabilitation facility, and your VA office to discuss your options. In order to check your VA Choice coverage, it is best to use an online form to verify your benefits, or to give a call to a reliable service provider.8

When you contact your local American Addiction Centers facility, you will already start the admission process. One of the trained and experienced admissions officers will help you verify your insurance plan and give you a thorough walkthrough of the process of picking the most suitable facility in line with your specific needs.8

In case of any urgency, such as a need for an emergency detoxification, veterans struggling with SUD and their families can rely on reliable hotlines that are available around the clock. In that case, you will get the relevant information and necessary support to start your journey to a healthier lifestyle.8,10

Frequently Asked Questions