VA Health Care Benefits and the MISSION Act

Veterans Affairs (VA) recognizes the need for specialized care for Vets and their benefits provide coverage for a wide range of substance abuse and mental health services.2 Also, through the MISSION Act, the VA makes allowances for Veterans who cannot access treatment at a VA facility to find the help they need at non-VA providers in the community.3

The VA also lets Veterans stack VA benefits with other health insurance coverage.4 If you’re unsure what benefits you have, we can help. Fill out this quick and easy to find out if you’re covered for treatment at an American Addiction Centers facility.

What Will the VA Cover?

Does VA Healthcare Cover Addiction and Mental Health Treatment?

a member of the VA staff interviews a servicememberYes, VA benefits include mental health and substance abuse treatment for Veterans.2 In fact, all healthcare insurance and benefits in the United States must cover addiction treatment in some capacity, thanks to the Mental Health Parity and Addiction Equity Act.5

Unfortunately, substance abuse and mental health issues are quite common for the Veteran population and occur at rates higher than the general population. More than 1 in 10 Veterans has a substance use disorder, and many other Veterans suffer from chronic pain, suicidal thoughts, and post-traumatic stress disorder (PTSD).1 Some of the covered mental health services the VA provides include:2

  • Medically managed detoxification.
  • Residential inpatient care.
  • Intensive outpatient treatment.
  • Outpatient counseling.
  • Family counseling.
  • Continuing care/relapse prevention.
  • Maintenance medications (e.g., methadone and buprenorphine for opioid addiction).
  • Specialized programs for specific populations such as women Veterans, homeless Veterans, etc.).

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

If you have VA benefits along with other health insurance, the coverage will stack. This means you can use both your VA benefits and coverage such as:4

  • Private insurance plans.
  • Medicare.
  • Medicaid.

Your VA benefits cover your service-connected conditions, while your other health insurance will be billed for any other type of care. As an example, if you’re suffering from PTSD related to your time in the service along with a co-occurring substance use disorder, the VA might cover PTSD treatment, but they might bill your substance abuse treatment claim to your primary insurance.4

That said, if your health insurance doesn’t cover a portion of your bill, you won’t have to pay for those services.4

Accessing Treatment Through the VA

How Do I Get Addiction Treatment with VA Health Care?

To receive treatment for mental health and substance abuse, you will need VA benefits and will need to find treatment through the VA. Most often, this means accessing care at a VA facility.

However, sometimes VA facilities may be too overloaded, too far from you, or may not offer the specialized treatment you need in your area. In this case, you may be able to receive community care—treatment with a non-VA provider in the VA’s community care network—through the MISSION Act.6

MISSION Act Improves Access to Community Care Programs

The MISSION Act improves the substance abuse and mental health treatment options available for Vets.6,7 The program allows Vets who meet certain eligibility requirements to seek care through a VA facility, urgent care or walk-in clinic, telehealth, or a community care provider.7

Community care providers are medical and mental health professionals outside of the VA healthcare system who are allowed to provide services to Vets through the Community Care Program.8 If a Vet is eligible, the VA will pay for visits with an approved provider.

The MISSION Act is also gradually expanding support for family caregivers by giving more families access to the Program of Comprehensive Assistance for Family Caregivers.6 This allows family members who provide care for disabled Veterans to receive a monthly stipend to help cover expenses, as well as other support services.

At the current time, family caregivers of Vets injured in the line of duty either on or after September 11, 2001, qualify. 6 It will later expand to family caregivers of Vets injured in the line of duty before May 7, 1975 and then later to those injured between May 7, 1975 and September 11, 2001.6 The expansion of the program under the MISSION Act includes ensuring that the definition of “serious injury” includes any service-related disability, including mental health conditions. 6

Since the passing of the MISSION Act, Vets have more opportunities to access medical and mental health treatment. Healthcare is now available through the VA and community care providers. However, Vets who are interested in seeing a community provider must first receive authorization through the VA.8

VA MISSION Act Eligibility Criteria

In order to see a community care provider (CCP) through the MISSION Act, Vets must meet certain eligibility requirements. The following are cases in which Vets may receive approval by the VA to see a CCP:11

  • The Vet requires a medical service that cannot be provided by a VA facility.
  • The Vet lives in a state or territory without a full-service VA facility. This is true for Vets who live in New Hampshire, Alaska, Hawaii, Guam, the Northern Mariana Islands, American Samoa, and the U.S. Virgin Islands.
  • The VA’s care does not meet the standards of quality for the specific condition.
  • The VA is unable to provide an appointment within 20 days for primary care or mental health services or within 28 days for specialty care.
  • The average driving time to a VA facility is more than 30 minutes from the Vet’s home for primary care or mental health services or more than 60 minutes for specialty care.
  • The Vet is “grandfathered” into the Veterans Choice Program (VCP). For example, a Veteran may be eligible for community care if they were previously eligible for the 40-mile driving distance criterion through the VCP.
  • It is deemed that it is in the Vet’s best interest to seek care from a community provider. For example, if a VA healthcare provider is not experienced in treating a certain condition, it may be determined that it is best for the Vet to seek treatment through an outside specialist.
Where to Get Community Care

VA Community Care Network Providers

a child greets her mother upon completion of military deployment

The first step in finding a community care provider is determining if you are eligible for the program. 3 For questions about whether you qualify, speak with a VA staff member.

Once you’ve been given approval to see a community care provider, you can either ask a VA staff member for assistance or conduct a search on your own. 3 The VA’s website offers the VA Facility Locator tool. Under “choose a VA facility type,” select “community providers.” Also be sure to include your address and specialty. This tool will identify local community care providers that are in the VA network.

Laguna Treatment Center is part of the VA community care network, meaning that Veterans are able to access substance use disorder treatment at our facility using their VA benefits.

At Laguna, we offer a specialized addiction treatment program for military Veterans from all branches of the U.S. Armed Forces, as well as current and retired first responders. The program provides a safe place for these individuals to begin a path to recovery among peers who understand the high-stress nature of their professions.

We use an integrated treatment approach with evidence-based therapies that can help Vets address their substance use and mental health struggles at the same time. With the support of one another and qualified staff, Vets can recover from addiction and mental illness.

Call us at any time of day, any day of the week to learn more about how we can help you.

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