VA Mission Act: Guide & Eligibility for Healthcare Benefits
WHAT YOU NEED TO KNOW
- The VA MISSION Act expanded veterans’ access to care, including at approved community providers
- Signed in 2018 and effective June 2019, it consolidated VA community care programs
- Eligibility hinges on access standards like drive time and wait time for VA care
- It can cover addiction treatment, from detox to inpatient rehab, at approved providers
- Veterans generally need VA approval and a referral before using community care
What Is the VA MISSION Act?
The VA MISSION Act changed how the VA delivers care for veterans.
It became law in 2018 and started helping with community care in June 2019. The goal is simple: make it easier for veterans to get the care they need, with better access and quality.
The Act covers a lot. It helps with care outside the VA, in-network care, prescriptions, and even support for veterans’ homes. It also makes it easier to get help for drug or alcohol use.
If you are looking for help with substance use and the VA is too far, has long waits, or does not offer the care you need, the MISSION Act can help you get treatment at an approved private rehab.
How the MISSION Act Changed Veterans’ Care
Before the MISSION Act, getting care through the VA could mean waiting weeks or driving hours. The average wait for an appointment was about 21 days. Many veterans live far from a VA center.
The MISSION Act lets eligible veterans see a provider in the VA’s Community Care Network, helping them avoid long waits or long distances. It also consolidated the VA’s community care programs, including the Veterans Choice Program, into one system that is easier to navigate.
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:
- Desert Hope: Las Vegas, Nevada.
- Greenhouse Treatment Center: Dallas, TX.
- Recovery First: Hollywood, Florida.
- River Oaks: Tampa, FL.
- Oxford Treatment Center: Etta, MS.
- AdCare Rhode Island: North Kingstown, RI.
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.