VA Benefits, MISSION Act & VA Community Care Program for Veterans

VA benefits cover substance abuse treatment services for veterans in Texas. The VA not only allows you to use your VA healthcare at their facilities, but they also will allow you to receive care at non-VA community facilities if you meet the community care eligibility requirements.  Finally, you can also use your VA benefits in combination with other insurance plans for even more comprehensive coverage.

If you are struggling with addiction and you need help but are unsure of what your benefits cover, we can help you.
 

Do VA Benefits Cover Substance Abuse and Mental Health Disorders?

a veteran and his wife meet with a treatment team

The VA does provide coverage for mental health and substance abuse—issues veterans face in high numbers. More than 1.7 million veterans received mental health services through the VA in the last year.1

Substance abuse very commonly occurs with other mental health disorders. The presence of both is called co-occurring disorders, and it’s imperative to treat all disorders simultaneously. As a veteran with VA coverage, you can receive services for many issues including but not limited to:2

  • Substance abuse.
  • Post-traumatic stress disorder (PTSD).
  • Military sexual trauma.
  • Suicide.
  • Homelessness.

Mental health treatment services that you can receive through VA insurance include:2,3

What if I Have VA Insurance and Another Health Insurance Plan?

What should you do if you have VA benefits and another insurance plan in Texas? That’s not a problem. You can use both insurance policies. Having other health insurance (e.g, TRICARE, Medicaid, Medicare, or private insurance) and VA benefits can help defray some of your out-of-pocket costs. One policy may cover what the other one does not. Even your co-pay might be covered with the use of both policies.4

How Do I Get Addiction Treatment Through VA Insurance?

If you’re wondering exactly how to access the care you need in Texas, you can discuss your needs with your primary VA healthcare provider.3  You will need to have VA coverage to do so. If you don’t already have it, you can apply online with the VA.5

Once you’ve met with your VA healthcare provider, he or she can help you find a treatment program near you that can meet your needs.1

If you don’t already have a primary provider with the VA, you can search online for your nearest facility.1

If you’re not sure where to start or you don’t know what kind of treatment you’re looking for, you can call  877-222-8387 for help in getting started.1

What if the VA Can’t Treat Me? Getting Community Care with VA Benefits

There are many veterans seeking treatment with the VA, and the VA is unable to meet the needs of every veteran in their VA facilities. This is where community care comes in. The VA has a network of non-VA community care providers (CCPs) that they allow veterans to attend using their VA benefits.

The MISSION Act of 2018 expanded access to community care, making it easier for veterans in need to get help in the community.6

What Is The VA MISSION Act?

In 2019, legislation called the MISSION Act was passed to increase a veteran’s ability to access needed healthcare services. The MISSION Act made it easier for veterans to receive all types of medical and behavioral health services from non-VA providers in their communities.7

The MISSION Act was created to provide veterans a wider array of healthcare options in their communities. It was designed to enhance, rather than replace, VA services, with a particular goal of improving veterans’ access to both urgent care and community care.7

The VA implemented this as a replacement for the Veterans Choice Program (VCP), which allowed veterans in some circumstances to be treated in non-VA facilities.7,8 The MISSION Act allows veterans to use community providers that are in the VA network. Veterans who are eligible for community care are not obligated to use it; they can choose a VA facility if that is their preferred option.8

In most cases, veterans who do wish to utilize community care still need to start with the VA to determine if they are eligible before initiating care at a CCP. VA staff will usually make any determinations regarding eligibility.8 In most cases, the VA will coordinate treatment and make appointments for the veteran, though in some cases the veteran may be able to schedule his or her own appointment.8

The MISSION Act improves a veteran’s ability to access community care, streamlines processes and guidelines for better customer service, and requires timely payments to the care provider—all of which improve the experience of treatment-seeking for the veteran.8

Finding a Rehab in the VA Community Care Network

Community care providers (CCPs) are non-VA providers of all types who have agreed to become part of the VA network and accept VA reimbursement for healthcare services provided to veterans. Although the MISSION Act increases a veteran’s ability to access community care, this doesn’t mean that a veteran can go to any provider that he or she chooses.

The provider must be community care provider-certified with the VA. The CCP will be paid by the VA directly.9   There may be a copayment for services, and the veteran may be able to use additional healthcare coverage such as TRICARE, Medicaid, and/or Medicare.10

To locate a CCP you can go through the VA website. The CCP networks are divided into 6 regions across the United States. Regions 1, 2, and 3 are managed by a third-party administrator called Optum. Their website offers a way to search for CCPs.9

Region 4, which covers Nevada and surrounding states is managed by Triwest.9

Regions 5 and 6 cover Alaska, American Samoa, Guam, and the Northern Mariana Islands.9

Community Care with Greenhouse Treatment Center

Greenhouse front desk

Greenhouse Treatment Center has partnered with the VA to provide high-quality care for veterans outside of the VA and is now an approved community care provider.

Greenhouse Treatment Centers veterans program, Salute to Recovery, is tailored to the unique needs of veterans who are struggling with addiction and co-occurring mental health disorders. Many of the staff members are veterans and will understand and relate to the challenges of participants in the program.

One unique feature of our veterans program is that all patients live together and receive treatment as a group. During the program, the veterans in the program form a “battalion”—a group of people working toward recovery together who understand each other’s struggles and who can act as a lifelong support network.

To learn more about our Salute to Recovery program and to discuss how we can help you use your VA coverage to get private treatment, call us at .

Community Care Eligibility

Eligibility for community care is not automatic for all veterans. Specific criteria must be met for a veteran to get treatment through a CCP, rather than the VA. The VA makes the final determination if a veteran is eligible for community care, but at least one of the following criteria must be met:11

  • A veteran needs treatment that is not available through the VA. For example, a female veteran who requires maternity care, which is not available through the VA, may be eligible to go to a CCP.
  • A veteran lives in an area without a full-service VA facility, which would include U.S. territories such as the U.S. Virgin Islands, Guam, and American Samoa, as well as the states of New Hampshire, Hawaii, and Alaska. The veteran is eligible under “grandfathered” distance provisions. Under the Veteran’s Choice Act, veterans who lived more than 40 miles from a VA were generally eligible for community care. If the veteran continues to live in such an area, they may be able to receive community care if they live in Montana, North Dakota, South Dakota, Alaska or Wyoming, or if they live in another state AND received care between June 6, 2017 and June 6, 2018 AND requires care before June 6, 2020.
  • The VA is not able to provide care within certain standards of wait time for appointments, which generally means that the VA must be able to provide an appointment for a veteran for general medical or mental health care within 20 days. For specialty care, the days until an appointment must be no more than 28 days. If the VA cannot provide the veteran treatment during this time period and the veteran does not agree to the delay, the veteran can seek care through a community provider.
  • It takes the veteran more than 30 minutes to get to a general care appointment or more than 60 minutes for specialty care appointments.
  • The veteran needs specialized care that is not available at the VA and the veteran and referring doctor agree that it is in the veteran’s best interest to get this care from a community provider. For example, if the VA does not have an expert on staff to treat a particular type of cancer, and a community provider can give the veteran the expert care, the VA can approve for the veteran to obtain this specialty treatment.
  • The VA services provided don’t meet the criteria for what would be considered quality care.

Frequently Asked Questions about Community Care

Some of the most commonly asked questions about community care are included below.11

How does the VA determine if I am eligible for community care?

You can view the section above for general eligibility criteria. The VA will also work with you to determine if you are eligible to receive care with a CCP.

Do my community care appointments have to be authorized in advance?

Generally, yes. The VA must authorize your appointments ahead of time in most cases, unless you are visiting an urgent care center in the VA network.

If I reside close to a VA center, can I still get community care appointments?

Maybe. Under certain circumstances, even if you live close to the VA, you may qualify for community care. For example, if the VA cannot give you a routine care appointment within 20 days, you may be able to obtain a community care authorization through the VA.

Do I have to use community care?

No, you can still choose to access services at the VA, even if you qualify for community care.

The VA doesn’t offer the service I need. Does this mean I can automatically get community care without going through the VA?

No. You may very well be eligible to receive community care through the VA, but you still need to go through the VA to ensure that this is the case.

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