The Veterans Choice Program for Treating Addiction

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Veterans of the American military represent an extremely sensitive group of individuals in regards to their potential for the development of different types of substance abuse disorders. What’s more, there are many co-occurring mental health problems characteristic for veterans. There’s also the added factor that further complicates this matter of veterans often being treated for chronic pain with opioids, which can lead to the development of an SUD. Finally, the majority of veterans, as many as 70%, severely underestimate their potential for overdosing, stating that their risk is vastly lower when compared to an average adult citizen of the United States.1

There is also a very large number of veterans battling different psychiatric disorders, most often PTSD, anxiety, and depression alongside other medical issues. All these troubles are further emphasized by high rates of suicide ideation, with suicides of approximately 30% of all military personnel occurring following a case of substance abuse, mostly alcohol and drugs, while 20% of their deaths were a direct consequence of drug or alcohol overdose.2

This is why the reduction of mental health issues and substance abuse in the veteran population has been the primary goal of numerous services and programs, including the former Veterans Choice Program, currently the Veterans Community Care Program. The majority of these programs consist of therapies which combine a pharmacological and behavioral approach in an attempt to provide assistance during the veterans’ struggles to overcome their substance abuse addiction and co-occurring mental health disorders. However, even with all these efforts, the SUD rates among veterans in the U. S. are still on the rise.2

What Insurance is Available Under the Veterans Choice Program?

VCP, or the Veterans Choice Program, was envisioned as a temporary program, first started in 2014 on behalf of the VA, or the Department of Veterans Affairs in the United States of America. Its main goal was enabling eligible veterans to find the help they needed through access to different community healthcare institutions and programs. The single biggest advantage of VCP was its potential to render appropriate medical care and attention to veterans from both non-VA institutions, as well as those institutions within the auspices of the VA.3

The VCP also provided ample flexibility to all eligible veterans in choosing whether to enter a facility within the VA network or one of the community healthcare facilities in their vicinity. They had the choice of using the facilities available under the VA Choice Program to receive one type of medical assistance and those facilities available in the VA network for other types of medical assistance. This program allowed veterans to seek immediate medical attention at a community healthcare facility rather than traveling a longer distance to a VA facility or waiting for an open appointment slot at a nearby VA healthcare institution.3

The MISSION Act, ratified in 2018, ended the Veterans Choice Program alongside all existing VCP agreements by June 6, 2019, the official “sunset” date for this program. Since then, veterans could benefit from a replacement program called Veterans Community Care Program, available for providing medical assistance to former military personnel across the nation.4

Will the VCP Insurance Provide Coverage for Drug and Alcohol Treatment?

In addition to different types of healthcare services available to veterans, VCP insurance also offers a wide range of SUD treatment solutions to those former members of the Armed Forces who are struggling to overcome their drug or alcohol problem. This form of medical assistance represents one of the main types of health benefits proscribed by the ACA, or the Affordable Care Act.5, 6

This act requires all long-term healthcare insurance plans to provide coverage for SUD rehab and treatment, mental healthcare, counseling and psychotherapy as forms of behavioral treatment, as well as behavioral health and mental health inpatient assistance. Available coverage provided for VA healthcare services includes treatment for SUDs and other related conditions, such as PTSD, or post-traumatic stress disorder, depression, anxiety, and others.7, 8

Which Coverage Plans and Levels Will the VC Insurance Program Provide?

Concerning the coverage available under this form of the VA insurance program, veterans can be eligible to receive all the most common types of required medical services. However, not all veterans are eligible for additional benefits, as complete eligibility for all benefits can be dependent on:5

  • Medical treatment standards for each specific condition.
  • Primary practitioner’s advice.
  • Priority group the veteran was placed in during enrollment in an effort to balance out demand with available resources.

This means that the healthcare package available under the VC Insurance Program is unique for each veteran. However, every type and amount of healthcare insurance coverage for veterans will include:5

  • Quality of life enhancement.
  • Functional ability improvement.
  • Future health problem prevention.
  • Injury and illness treatment.

Patients receive referrals to a community care healthcare facility when the VA isn’t able to offer required medical services. This factor allows veterans to be eligible for receiving treatment from a community provider in their vicinity. However, the potential to receive treatment from community healthcare facilities will also depend on their unique circumstances and needs, as well as their VCP insurance eligibility. Also, it’s worth noting that veterans retain the right to alternate between VA and community facilities based on the exact type of treatment and care they require.6

How Can I Check My Rehab Coverage Under the Veterans Choice Program

The first action you should take when attempting to locate the most suitable facility for your particular medical condition is to determine your exact amount of coverage. The Veterans Choice Program isn’t an insurance plan guaranteeing complete coverage for all veterans looking for medical care and attention.3

To inquire about your level of coverage and your options regarding medical treatment, you can either check the VA’s online location database or contact them via phone in order to locate an appropriate in-network provider. The VCP hotline is available at (866) 606-8198 while you can also visit their online presentation to ascertain your eligibility. What’s more, the VA Community Care web presentation offers a number of suitable resources listing all the currently available medical treatment options.9

Finally, turn to American Addiction Centers, a reputable treatment provider that cooperates with the Veterans Administration and works to assist veterans who are recovering from their substance abuse disorder. You can find adequate options for treatment and check your benefit coverage by contacting AAC either online by submitting a benefit verification form or via phone. Either way, these professionals will provide accurate and prompt information you need.

What SUD Treatment Is Available in the VC Insurance Program?

Besides mental, surgical, and medical healthcare coverage alongside required medication, standard benefits under the VC Insurance Program include an extent of treatment options for substance abuse disorders. However, it’s worth emphasizing that VCP doesn’t provide coverage for emergency and long-term care.3

Owing to the fact that drug and alcohol abuse rates are usually higher among veterans of the Armed Forces, adequate treatment requires varying levels of care which depend on the unique circumstances of each individual veteran’s case. Some treatments require complete coverage, while others only partial coverage. Generally covered treatment options are:5

  • Support groups and therapy.
  • Outpatient rehab, treatment, and counseling.
  • IOPs, or Intensive Outpatient Programs.
  • PHP, or Partial Hospitalization Programs allowing patients to remain at their own home while attending daily SUD treatment sessions.
  • Inpatient and residential care and treatment.
  • Drug substitution therapy which fosters the use of appropriate medication in an effort to alleviate withdrawal symptoms, reduce cravings, as well as prevent relapse.
  • Medically managed detox aimed at helping patients through withdrawal.
  • Relapse prevention and aftercare protocols.

There are also times when a veteran can obtain partial or complete coverage for other specialized forms of substance abuse treatment, such as treatment for veteran couples or rehab and treatment for men no longer in active military service.5

Does the Veterans Choice Program Offer Coverage for Mental Health Issues?

The ACA, or the Affordable Care Act of 2010 passed the requirement on all healthcare insurance providers to offer coverage for 10 vital health benefits, including SUD and mental health treatment solutions. The VA provides resources for treating a wide range of mental health problems, including: 10, 11, 12

  • Suicide prevention: This the foremost priority on part of the VA and is essential for offering adequate mental health treatment for military veterans.
  • Bipolar disorder: This mental health problem manifests with a wide array of symptoms, most commonly energy and mood swings.
  • PTSD, or post-traumatic stress disorder: This is a problem which occurs following extremely traumatic experiences and events. It’s responsible for anxiety, sleeplessness, and nightmares, all of which disrupt a veteran’s day-to-day life.
  • Depression: The VCP offers ample treatment options aimed at helping veterans overcoming this extremely difficult condition and continuing with their life.
  • Anxiety: As many as one-third of the adult population experiences a form of anxiety, especially among the veteran community. The VA offers professional counseling to assist with anxiety trigger management.

Many veterans tend to suffer from a combination of mental health issues and SUD, which is why there is also the potential for the insurance to provide coverage for dual-diagnosis treatment as well. Professionals working with the VA will treat SUDs and co-occurring issues implementing evidence-based practices with local VA centers offering different forms of short-term interventions based on behavioral treatment:2, 13

  • MET, or Motivational Enhancement Therapy: This treatment is a version of Motivational Interviewing focusing on altering alcohol and drug abuse behavior.
  • MI, or Motivational Interviewing: This type of therapy focuses on detecting motivation to change and strengthening it.
  • CBT, or Cognitive Behavioral Therapy: This form of treatment helps veterans foster helpful and balanced thoughts with themselves, their future, and other individuals present in their lives.

Does the Veterans Choice Program Provide Coverage for Luxury and Private Rehab Facilities?

The Health Administration of the VA represents the single biggest integrated system for healthcare services in the United States with available treatment options suitable for a multitude of different cases. The Veterans Administration offers different types of alcohol and drug treatment dependent on the individual needs and requirements of each veteran seeking assistance, which means there are varying levels of coverage available.14

In order to receive complete benefits from the VC Program, you need to choose a treatment facility which is within the network covered by the VA. What’s more, it’s important to emphasize that you can combine VCP with other forms of healthcare insurance, meaning veterans can be eligible to receive combined coverage for all private treatment and rehab facilities. It might even be possible to receive coverage for a luxury alcohol or drug rehab facility because different specialized centers across the nation accept different payment plans and healthcare coverage. The VA represents a comprehensive healthcare network capable of providing coverage for a wide range of available treatment solutions in combination with private insurance plans.3

If you’re looking for a way to make the best out of a VA Choice healthcare program, you’re required to supply complete private insurance information. After this, you’re not responsible for making copayments for private health insurance.15

Which States Offer Coverage Under the VA Choice Program?

In general, the VCP is an available option for veterans residing across the nation if they’re “Mileage Eligible”, that is if they live either more than forty miles away from a VA healthcare facility or in a territory or state without access to a full-service VA healthcare facility. If the latter is true, the veteran in question will receive VCP care provided their residence is located 20+ miles away from a Veterans Administration healthcare facility or within one of these locals:10

  • U.S. territories, excluding Puerto Rico.
  • New Hampshire, excluding those veterans which reside more than 20 miles from the Veterans Administration White River Junction.
  • Hawaii.
  • Alaska.

The only exception remains the Commonwealth of Massachusetts in which the VCP operates as Medicaid. Owing to the Healthcare Reform Law passed in 2007, Medicaid and the VCP collaborate under the name of MassHealth Community Partners. Regardless of the name, this collaboration offers healthcare help to eligible veterans living across the entire state, from Berkshire to Suffolk County and the areas of Essex, Plymouth, and Worcester. Finally, medical care is available for veterans residing in major cities such as Plymouth, Lowell, Cambridge, Springfield, and Boston.16, 17

How Much VA Choice Coverage Is Available for Treating Addiction?

The Veterans Administration is the main coordinator of the VCP, meaning that veterans aren’t responsible for making copayments to insurance companies themselves. In practice, veterans are only responsible for making VA copayments. However, it’s important to know that a veteran has to provide documentation to the VA Choice Program if they own private insurance coverage.18

When veterans who own private healthcare insurance that requires copay receive VA-related medical treatment by the hand of a private medical professional, they’re not liable for any amount of coverage from the VCP. Veterans who pay copayments toward the Veterans Administration fall under the same set of requirements and regulations as found under the VCP. On the other hand, veterans without a VA copay are eligible to receive medical care from a private doctor without having to make additional payments to the VA. Know that a veteran will still get a copay bill from their insurance company upon receiving treatment for a medical condition unrelated to the VA.3, 19

What Is the Eligibility Criteria for the Veterans Choice Program?

Besides being part of the VA healthcare system, in order to qualify for the Veterans Choice Program, they have to fulfill at least a single condition:3, 10

  • The Veterans Administration doesn’t provide access to services required.
  • The veteran is “waitlist-eligible” provided the VA isn’t able to schedule an appointment within a month.
  • The act of traveling to a VA facility creates a burden for the veteran or requires the use of ferry, boat, or air transportation.
  • The veteran is more than 40 miles away from the nearest medical facility within the VA network.
  • The veteran is eligible to receive VCP medical care if there are no VA facilities within the state or if they’re more than 20 miles away from the facility while living in:10
    • U.S. territories with the exception of Puerto Rico.
    • New Hampshire.
    • Hawaii.
    • Alaska.
  • The Veterans Administration service line doesn’t offer the appropriate standards of quality required to administer adequate medical care to the veteran.

What Is the Process for Receiving VA Choice Insurance Coverage for Addiction Rehab?

The Veterans Administration program provides coverage for services connected to a form of substance abuse treatment with the main requirement that all the elements and stages of the treatment need authorization. The primary step in receiving the necessary care for a substance abuse disorder is that the veteran first has to apply for healthcare under the VA. Upon signage the veteran receives two distinct options:9

  • If the veteran doesn’t have a primary care provider under the VA or if the veteran hasn’t use VA services at a prior date, they can receive the guidance and the information they need if they:
    • Contact the VA hotline by dialing (800) 827-1000.
    • Reach out to one of their local VA healthcare centers or search for it online in accordance with their location.
  • If the veteran already has a primary care provider under the VA, they should turn to them for assistance during the initial screening process. Upon completion of this process, they’ll be able to find adequate assistance for their SUD.

What Happens if the VA Choice Program Doesn’t Provide Full Cost Coverage?

Even if you have no healthcare benefits under the VA and even if you don’t have complete coverage for your required treatment, it’s still possible to receive the care you need:5

  • In case you’re at risk of becoming homeless or currently homeless, information on receiving the required healthcare services is available either on the online presentation of the VA or at the 24/7 toll-free National Call Center for Homeless Veterans – (877) 424-3838. An experienced helpline counselor will be there to offer any information you require regarding your needed medical care. Know that all calls are strictly confidential and in line with the private nature of your medical information.
  • In case you’re a veteran who served in one of the combat zones, free counseling with a private doctor is available, as well as a comprehensive assessment of your substance abuse alongside other forms of support.

Those veterans unable to receive complete coverage for their treatment can inquire about other payment solutions. There are treatment facilities which offer low-cost and free rehab. Also, the majority of rehab facilities for SUDs accept payments made out-of-pocket, so another option is to take out a loan or borrow money in order to cover the cost of your treatment.20

Frequently Asked Questions