CHAMPVA Insurance for Drug & Alcohol Rehab

The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) offers health coverage for spouses and children of military members and veterans who are rated permanently and totally disabled for a service related disability. These dependents do not qualify for TRICARE — if they do they are covered by TRICARE instead.

The program was established in 1973. Members can get care at a VA Medical Center or clinic. If your local clinic participates in the CHAMPVA Inhouse Treatment Initiative (CITI) you can get care through that program at no charge to you. You can also get care from non VA providers that accept CHAMPVA. Providers who accept TRICARE often accept CHAMPVA as well.

Does CHAMPVA Cover Addiction Rehab?

If addiction treatment is considered medically necessary you will be able to get at least some of the cost covered by CHAMPVA. The CHAMPVA Guide helps you understand what services are covered. You will need to get authorization for mental health or substance use care before you begin treatment.

How can you prove what’s medically necessary? You’ll want to work with your doctor to create a treatment plan that addresses your specific needs. That will help you know where to start with treatment and will prove what’s medically needed in your case.

According to the CHAMPVA Guide a beneficiary can have three substance use treatment periods covered in their lifetime. A substance use treatment period starts on the first day of covered treatment and ends 365 days later.

Many people have other insurance such as Medicare along with CHAMPVA. If that’s the case your other insurance is primary and CHAMPVA is secondary. If your primary insurance has already authorized your care then you don’t need to get another authorization from CHAMPVA.

What Inpatient Addiction Treatment Does CHAMPVA Cover?

CHAMPVA covers inpatient addiction treatment with prior authorization. The facility must be Medicare-certified or approved by TRICARE. The care you receive also needs to be medically necessary. It’s essential to get a treatment plan from your doctor to determine medically necessity.

Medical detox is a form of inpatient care where you are able to receive medical care for withdrawal symptoms as the substances leave your system.

Inpatient or residential treatment is limited to no more than one stay during one benefit period of 21 days. Some partial hospitalization rehab is considered inpatient care by CHAMPVA and is subject to the same limitations.

What Outpatient Rehab Does CHAMPVA Cover?

CHAMPVA covers outpatient rehab for substance use disorder. Outpatient rehab includes limited individual, family, and group therapy sessions. Outpatient treatment can vary in length and intensity.

The most intensive treatment is PHP (Partial Hospitalization Program), which is a full-time day program and is often classified the same as inpatient care in CHAMPVA coverage.

The two lower tiers of outpatient treatment are Intensive Outpatient Programs (IOPs) and General Outpatient. An IOP provides at least 9 hours of treatment in three sessions per week. General outpatient care meets once or twice per week. You can return home after treatment sessions in all outpatient treatment programs.

Does CHAMPVA Cover Methadone & Suboxone (MAT)?

CHAMPVA covers medical detox, which can use supportive FDA approved medication.

However, many medication-assisted treatment (MAT) programs switch a “safer” addictive drug for the substance being used. For example, they might replace illicit opioid use with prescribed Methadone, but Methadone is still an addictive drug. This type of treatment is not covered by CHAMPVA.

There’s another kind of MAT that provides you with medications that block the effects of substance misuse, and the medications themselves are not addictive. For example, Naltrexone is a blocker for opioids and alcohol and may be covered by CHAMPVA.

Does CHAMPVA Cover Other Mental Healthcare?

Mental healthcare is covered under CHAMPVA plans, but the number of visits you’re allowed per year is limited. The exact coverage depends on your plan and the type of treatment.

For example, you’ll need authorization for any acute mental health treatment that requires inpatient hospitalization. CHAMPVA also covers a total of 23 psychotherapy sessions per year for outpatient mental health treatment. Additional sessions require authorization.

How Long Will CHAMPVA Cover Rehab?

It’s important to fully embrace the treatment process and complete all the steps as outlined in your program. To that end, CHAMPVA gives patients 365 days to complete a full treatment program and establish long-term recovery.

The length of care in your specific program will vary depending on what you need. CHAMPVA also has limits on coverage of specific types of care.

The average residential program covers three to four weeks, while outpatient programs may run for as long as 90 days. You may also participate in an aftercare program when your treatment plan has finished.

Can I Travel Out of State for Treatment with CHAMPVA?

Unlike many insurance plans, CHAMPVA doesn’t have a provider network. You can choose your own provider, but it’s best if you find one that accepts assignment from the VA.

Fortunately, these providers exist in every state. You can still see a provider that doesn’t accept assignment but you will pay upfront and have to seek reimbursement. Costs will generally be much higher if you choose a provider that doesn’t accept VA assignments.

Choosing a VA-participating provider in whichever state you prefer will help you maximize your coverage and save money.

What to Do if CHAMPVA Won't Cover the Cost of Rehab?

Depending on your plan, CHAMPVA’s coverage for mental health and addiction treatment may not fully cover your rehab. If this happens, you might have to pay for rehab yourself or work with another insurance plan.

Even still, it’s very important to get the care you need. The good news is that there are a lot of options. Many treatment centers offer sliding scales for fees so you can pay less depending on your income. Sometimes there are also payment plans or scholarships available.

Another option is to look at free and low cost rehab programs such as Salvation Army or state or county run programs.