VA Insurance & The Mission Act for Substance Abuse Treatment

Do VA Benefits Cover Addiction Treatment and Rehab?

VA benefits provide services and treatments for mental health disorders as well as substance use disorders.² Some of the mental health services provided through the VA include:³

• Inpatient care.
• Residential care.
• Outpatient mental health care.
• Specialized PTSD programs.
• Sexual trauma treatment.
• Psychosocial rehabilitation & recovery programs.
• Substance use disorders.
• Suicide prevention programs.
• Evidence-based psychotherapy treatment.

VA benefits also offer specific substance use treatment services, including:⁴

• Medication-assisted detoxification and drug substitution therapies, including access to clinics that provide methadone and buprenorphine for opiate addiction.
• Intensive outpatient program treatment.
• Outpatient therapy.
• Group therapy, such as self-help therapy.
• Residential (live-in) care.
• Continuing care and aftercare programs.

Addiction Treatment Through VA Benefits & Community Care

Veterans will generally receive the treatment they need from the VA, but there are some cases when this is not possible such as when there are no facilities close by or the wait times are too long.¹

In cases like these, the VA may allow Veterans to receive care from community providers.⁴ These are private treatment providers authorized by the VA to treat Veterans when the VA is unable to do so.

In order to access community care, a Veteran will need to meet certain eligibility requirements, outlined below.

How Can I Use Community Care and the VA to Get Addiction Treatment?

If you are able to use a community care option through your VA benefits, look for programs that are sensitive to Veterans’ substance use concerns and have co-occurring disorder treatment programs targeted to Veterans’ specific issues. Sunrise House’s Veterans program, for example, is a VA-specialized treatment option that provides care when you need it most.

There are 6 eligibility criteria for community care, and a Veteran only needs to meet one of them to be eligible.⁵

As a Veteran, you may be able to get treatment with a community provider if:⁵

1. You need a specific kind of treatment that cannot be provided at a VA facility. An example is maternity care, as this is not provided by the VA.
2. The VA does not have an appropriate facility within an acceptable driving time from you. The driving time is considered unacceptable if it is more than a 30-min. average driving time for mental health services, primary care services, or extended care services (such as adult day care) or 60-min. average driving time for specialty services.
3. The wait time for an appropriate VA facility is considered unacceptable (unless the Veteran agrees to a longer wait time in consultation with a VA healthcare provider), such as more than 20 days for primary care, mental health services, or extended care services or more than 28 days from the date of request for specialty care.
4. It is in your best medical interest to get treatment through a community care provider. The referring clinician must agree that it is in your best interest to go outside the VA for care.
5. A specific VA medical service line for the type of care you need is not currently meeting the VA’s quality standards.
6. You qualify for community care under the “grandfather” provision as it relates to your distance eligibility under the VCP.

Even if you are eligible for community care, you still have the option to receive treatment through the VA if that’s your preference.⁶

How to Find a Community Care Program for Substance Abuse Treatment

If you are a Veteran interested in getting treatment through the community care program, there is a simple process to understand:^{5, 6}

1. Work with the VA to determine if you qualify for community care. In most cases, you need VA authorization to seek treatment with a community provider.
2. Make an appointment. A VA staff member will usually make an appointment for you with a community care provider, though you may be permitted to make the appointment yourself. You can select the provider yourself or get help from the VA, but the provider must be in the VA’s network of authorized community care providers.
3. Receive treatment from the community care provider.
4. The community care provider you used will send the claim to either the VA (or a third-party administrator contracted by the VA) to receive payment.

The VA makes it simple to find a community care provider in their network with their online locator tool.

Can I Use VA Benefits and Another Health Insurance Plan to Cover Substance Abuse Treatment?

If you have VA benefits and another insurance plan, you can use both for your treatment.⁷ You can check your insurance coverage for rehab or simply provide the information for both plans at the time of service.

It’s helpful to use your insurances in tandem because if your primary insurance won’t cover something, the VA benefits may cover the remaining amount. Other times, you may get your co-pay covered by using both insurances.⁷ There are other payment options to help cover the cost of treatment as well.

Some addiction treatment facilities may accept Medicaid, Medicare, and/or TriCare.

VA Community Care with American Addiction Centers

All of Sunrise House’s parent company American Addiction Centers’ (AAC) facilities are currently authorized community care providers in the VA’s network, providing substance use and mental health treatment to Veterans.

The Veterans program has been designed to address the unique issues that impact the lives of Veterans and that perpetuate the cycle of alcohol use disorder, drug use, and addiction. In the program, Veterans are treated alongside other Veterans and first responders.

For more information about our New Jersey drug and alcohol rehab center, call us at . Our admissions navigators are here 24/7 to help you understand your treatment options and the process of accessing community care through the VA.