VA Mission Act: Guide & Eligibility for Healthcare Benefits

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Published July 23, 2021

 

In June 2019, the Department of Veteran Affairs (VA) underwent a major transformation when the VA Mission Act went into effect. The Mission Act’s aim is to improve the way healthcare is provided for veterans. The VA Mission Act has expanded veterans’ access to healthcare and improved the quality of care veterans receive. The Mission Act addresses non-VA healthcare access, in-network VA care, veterans’ homes, prescription medications, and more. This includes improving access to treatment for drug and alcohol addiction—sometimes referred to as substance use disorder.1

The Mission Act allows veterans to access immediate care in VA-approved care facilities throughout the country. If you’re a veteran seeking substance abuse treatment, but the VA facilities are difficult for you to access, have long wait times, or do not provide specialized treatment tracks that meet your medical needs, you may be able to use the benefits provided by the VA Mission Act to access treatment at a private rehab facility.

Table of Contents

What is the VA Mission Act of 2019?

The VA Mission Act of 2019 is a law that allows veterans to receive health care immediately—including urgent care facilities — at approved care facilities throughout the United States. The Mission Act ensures that veterans have the ability to access a care provider of their choosing, regardless of whether or not that healthcare provider is part of the Veterans Health Administration or not.

Prior to the Mission Act, many veterans faced difficulty in obtaining healthcare in a timely fashion. Many veterans experienced long wait times to obtain care. The average wait time for a health care appointment at the VA is 21 days, and many veterans do not live close to a VA center and have to travel long distances to get care at a VA facility.2 The Mission Act allows veterans to see a healthcare provider who is part of the VA’s Community Care network. This can help veterans circumvent the long wait times or physical distance of the VA.

The Mission Act consolidates the VA’s community care programs, including Veteran’s Choice, into a new program that makes it easier for veterans to navigate the healthcare system. The act also allows community (outside of the VA) providers to interact with the VA more easily with new IT systems, improved communications, and timely payments from the VA.

While the VA Mission Act allows veterans to have a greater degree of choice over their healthcare providers, there are some restrictions to be aware of. Veterans cannot schedule appointments with specialists—including mental health and substance abuse providers—without a referral.

What Are the Pros & Cons of the Mission Act for Veterans?

Recent estimates suggest that more than 2.6 million veterans were referred to community providers in the first 18 months since the Mission Act went into effect.3 Before the enactment, veterans received care exclusively from the VA. If a particular service was not available at the closest VA, veterans were sent to the next closest VA, which would often entail traveling long distances for healthcare.

Apart from faster, easier access to healthcare, the Mission Act has other pros, including:

  • Ability to choose healthcare providers. Veterans can choose whichever healthcare providers they wish, whether they are in the VA network or not.
  • Decreased wait times to access care.
  • Veterans living in remote and rural areas can access care locally.
  • Increased continuity of care between providers for veteran patients. Thanks to improved technology and communication systems, different healthcare providers with the same patient can share patient information more readily, ensuring continuity of care.
  • Increased funding. Increased budget for healthcare for veterans may improve the VA’s ability to recruit and hire qualified medical professionals to work at VA facilities, thanks to the scholarship program now funded by the government for VA doctors.4

While the Mission Act is wonderful in many ways, some believe that there are downsides to the Act. Cons of the Mission Act include:

  • Loss of specialized care. VA doctors are trained to meet the special needs of veterans. Not all community healthcare providers are well-versed in veteran-specific issues
  • Potential decrease in resources. Some people believe that the privatization of health services for veterans will lead to a decrease in funds for VA facilities, leading to higher out-of-pocket costs for veterans.

VA Mission Act Eligibility

If you’re a veteran, you may be wondering if you are eligible to receive healthcare services as part of the Mission Act. Eligibility requirements to qualify for the Mission Act include:1,5,6

  • Be enrolled in VA healthcare or be eligible for VA healthcare
  • Receive approval from the VA before visiting community providers

Eligibility depends on meeting one or more of the following criteria:

  • Receiving community care is in the veteran’s best medical interests
  • The services needed are cannot be provided at a VA facility
  • VA can’t provide care within designated access standards (e.g., drive time of 30 minutes or waiting period of 20 days for primary/mental health care, or 60 minutes or wait of 28 days for specialist care)
  • Quality standards are not met at a VA facility
  • Veteran’s home state does not have full-service VA facility

The Mission Act has amended the VCP to benefit more veterans and allows veterans to use community health services without requiring private health insurance.

The Mission Act & Substance Abuse Treatment

The Mission Act may provide treatment for veterans with substance use disorder. An assessment will be done in order to determine the level of care for your addiction rehabilitation needs. The Mission Act increases the choice for veterans to access substance abuse and mental health treatment options, allowing veterans to access care through a VA facility, urgent or walk-in facility, telehealth, or with a community care provider. If a veteran is eligible, the VA will pay for visits with an approved community care provider.

In most cases, veterans must receive VA approval to access drug and alcohol addiction treatment outside of the VA in order for the VA to cover the costs of the treatment. If the criteria are met and the VA approves the veteran to seek treatment outside of the VA, the  following services for addiction treatment may be covered:7

  • Medical detox. Medically assisted detox involves medical staff working with you to help you safely and comfortably withdraw from drugs and alcohol. Medications are used to help manage withdrawal symptoms, and medical supervision is provided around the clock to ensure you safely withdraw from the substances you use.
  • Inpatient or residential rehab. Inpatient rehab centers involve living at the treatment facility for a certain number of days (anywhere from 15-90 days, typically) in order to get the medical and emotional support needed for sobriety and recovery.
  • Partial hospitalization programs (PHP). Better known as “day treatment”, PHP programs allow patients to live at home while attending treatment programs during the day.
  • Intensive outpatient (IOP). For those who have completed residential/inpatient treatment and would like ongoing support and treatment, IOPs provide ongoing treatment. These programs involve attending approximately 3-5 evenings a week.
  • Outpatient rehab/therapy. Outpatient treatment allows you to live at home while attending treatment for 10-12 hours a week (e.g., therapy, meetings) in order to complete the program.
  • After you’ve completed inpatient or outpatient treatment programs, ongoing support is still an important part of your long-term recovery and sobriety. This may include individual, family and group therapy, and attending 12-step meetings.

How Do I Use the VA Mission Act?

To use the VA Mission Act, the first step is to make an appointment at your closest VA, where they will determine if you are eligible for care.5 Once you’ve received authorization from the VA for care outside of the VA network, you can search for an approved provider, or the VA staff can assist you in finding one. Then, you can schedule an appointment or admissions chat, notify the VA. They will send your referral to the provider and you. For more information, contact the VA. You can reach the VA Mission Act information line at 1-800-698-2411.

How to Find Mission Act Providers?

When you’ve found a provider or treatment facility you’d like to get care from, confirm that they are approved by the VA. If they are not, you can ask the VA to approve the provider for you. Alternatively, you can use the VA Facility Locator tool on their website. Under “choose a VA facility type”, select “community providers”. In the search, include your address and the specialized care you want to access. This tool will help you identify care providers and rehab facilities that are approved by the VA and within the VA network.

There are a number of VA-approved drug and alcohol rehab facilities throughout the country to choose from, including:

Each of these facilities offers evidence-based therapies to help veterans address their substance use and mental health struggles. With the help of qualified, supportive staff and other veterans who are going through similar struggles, veterans can recover from mental health conditions and addiction.

Start Your Recovery Today!

Contact us today to talk with an Admissions Navigator who will give you the information you need to make the right decision for you and your loved ones.

Sources

  1. Military Benefits. VA Mission Act.
  2. Military Times. (2019). New VA plan: Vets facing 30-minute drives, 20-day waits for appointments could get private-sector care instead.
  3. Mattocks KM, Kroll-Desrosiers A, Kinney R, Elwy AR, Cunningham KJ, Mengeling MA. Med Care. 2021. Understanding VA’s Use of and Relationships With Community Care Providers Under the MISSION Act.
  4. VA Careers. (2021). Health Professional Scholarship Program.
  5. U.S. Department of Veterans Affairs. (2019). Community care.
  6. U.S. Department of Veterans Affairs. (2019). Veteran community care eligibility.
  7. National Institute on Drug Abuse. (2018). Principles of drug addiction treatment: A research-based guide (3rd edition).