VA Community Care Health Coverage for Drug Rehab

The VA Community Care Program is part of the broader Veterans Affairs Health System. The program lets eligible veterans receive care from community providers outside of VA facilities when a VA hospital or clinic isn’t accessible or the wait time is too long. The CCN was established in 2018 to provide veterans with timely and accessible health care, especially for those who cannot readily access VA healthcare facilities or when specific services are unavailable.

Your eligibility hinges on the availability of services at a local VA facility or quality concerns at an existing VA service along with specific healthcare needs that are better met through community providers. Veterans living in states without full service VA medical facilities, such as in Alaska or Hawaii, are typically eligible. The CCN does not require preauthorization for urgent care services. For regular appointments or specialized care you will need a VA referral and could still have wait times.

Does VA Community Care Cover Addiction Rehab?

VA Community Care is an extension of VA Healthcare services. To use a CCN facility the VA must provide a referral. Your primary care provider in the VA can initiate a referral that must pass a comprehensive review by the Community Care Department.

VA Community Care can cover a comprehensive range of addiction treatment. Treatment is not a one size fits all process and your customized treatment program may require medical detoxification and/or inpatient or residential treatment and/or outpatient care. By working closely with your VA doctor you’ll be able to get a treatment plan that outlines exactly what you need which will help you get approved for CCN providers as needed.

When Would I Use VA Community Care Instead of the VA Hospital?

There are several circumstances under which you would use the VA Community Care services instead of a VA facility. Typically it involves the availability of service, timeliness of care, and geographic convenience.

You might receive care from a CCN provider if services are not available at your local VA facility or if you live in a location far from a VA facility. When the wait time to receive care is beyond 20 days for mental health services and when you and your health care clinician agree that care from community providers is in your best interest you might be eligible for CCN treatment.

Veterans in a U.S. state or territory without a full service VA medical facility are also eligible for care from local community providers. When the wait time for a service is longer than the standard wait time you’re eligible to seek care from a community provider. Another reason you and your VA clinician may agree that getting care from a community provider is in your best medical interest might be that the nature of the treatment or the expertise available in the community that differs greatly from the expertise available in the VA facility.

Community Care Networks are split across five regions in the U.S. You can receive rehabilitation and behavioral health therapy from community providers. They also cover complementary and integrative health services from in network community providers when the treatment is approved by your VA health team. Some of these integrative services may also be used in substance use disorder treatment such as relaxation techniques and biofeedback or even hypnotherapy.

You are advised to consult with your VA primary care provider so you better understand your eligibility under the Community Care program. Your VA provider can initiate the referral process when you meet eligibility requirements.

What Type of Inpatient Rehab Does VA Community Care Cover?

VA Community Care can cover inpatient substance use disorder treatment when it’s medically appropriate for you.

One criterion that may be used for inpatient or residential care is the American Society of Addiction Medicine (ASAM) assessment. This is a comprehensive set of guidelines used for assessment and treatment planning as well as identifying the appropriate level of care. These criteria include your current state of intoxication and potential for withdrawal issues as well as physical health issues and mental health conditions. The assessment also looks at your emotional stability and readiness and interest in changing your substance use behavior.

Once you begin treatment inpatient care may first focus on medical detoxification. Detox may use FDA cleared prescription drugs to reduce the effects of withdrawal. After the addictive substance has left your body you are transitioned into evidence based treatments to address your substance use disorder and mental health condition.

Treatment during inpatient or residential rehab can include cognitive behavioral therapy and dialectical behavior therapy along with motivational interviewing. Treatments are intended to identify negative thought patterns and behaviors that support addictive behavior and change those to develop healthier coping strategies.

What Type of Outpatient Addiction Treatment Does VA Community Care Cover?

CCN provides care after it’s approved by your VA healthcare provider and the Community Care Department. A treatment center will perform a comprehensive initial evaluation that helps identify the level of care needed. Your initial treatment may begin in an outpatient addiction program. These programs typically use many of the same therapies offered during an inpatient program but the treatment is less intensive.

Three levels of outpatient care might be covered. The first is a Partial Hospitalization Program (PHP) that provides intensive and highly structured treatment and allows you to go home in the evenings. These programs are sometimes called day programs.

An Intensive Outpatient Program (IOP) offers greater flexibility while still providing evidence based therapies to address substance use disorders and mental health conditions. You attend fewer hours per week and often have time to meet some of your work and school obligations.

Finally, you may graduate to a general outpatient care program in which you receive outpatient therapy once or twice weekly, including in individual and group therapy settings.

Does VA Community Care Cover Methadone & Suboxone (MAT)?

The VA has been covering some form of medication assisted treatment (MAT) since 2006. MAT can be used during medical detoxification to reduce symptoms of withdrawal and during ongoing treatment for opioid and alcohol use to reduce cravings and reduce the risk of relapse.

The type of medication prescribed depends on the addictive substance. For example, opioid use disorder treatment may include methadone or buprenorphine. A program may also use a combination of buprenorphine and Naltrexone called Suboxone. Alcohol use disorder may be treated with disulfiram or naltrexone or topiramate. Each of these drugs helps you stay stable during treatment and reduces the risk of relapse and overdose deaths.

Does Addiction Treatment Need to Be In Network?

To receive addiction treatment using your VA insurance you must use a VA clinic or get approval for treatment from an approved CCN. Although the VA may assist you with reimbursement for emergency urgent care from an out of network provider, addiction treatment does not generally fall under the category of emergency care.

In certain circumstances you may be able to receive non VA care if you are covered by a second non VA insurance plan. At that point you would be using your non VA insurance as primary and would need to follow the requirements and use the network of that plan.

You must work closely with the treatment center and your insurance providers to understand the requirements for coverage and how to submit claims. In some cases your secondary insurance provider may require a rejection from the VA system before they pay for services.

Does VA Community Care Cover Other Mental Healthcare?

The VA takes mental health care seriously and allows you to receive care from CCN approved providers after approval from VA health services. When you’re unable to get to a VA in person to receive mental health care they also offer an online self help portal and smartphone apps along with telemedicine health programs. When this is not enough CCN healthcare providers can offer crisis support and traditional outpatient therapy for mental health conditions and co occurring disorders.

Co occurring mental health conditions are common with substance use disorders and addiction. This is called a dual diagnosis and requires an integrated approach to care in which both disorders are treated simultaneously to achieve greater success and long term recovery. Mental health conditions can range from anxiety to depression or post-traumatic stress disorder. Veterans may also have issues with military sexual trauma or domestic violence or living with a disability.

What to Do if VA Community Care Won’t Cover the Cost of Rehab

The first step to getting care for substance use disorders and mental health conditions is to work with your VA primary care physician. If the VA is unable to meet your needs you may receive a referral to a CCN network provider. If your addiction or mental health condition does not meet VA criteria you may need to cover the cost of rehab yourself. There are several steps you can take to seek financial assistance.

You may qualify for Medicaid which will help cover the cost of addiction and treatment for mental health conditions. If you or your partner has another health insurance policy you may be able to receive care outside of the CCN and VA network. Many treatment centers have financial counselors who are willing to work with you to find financial assistance to help pay for treatment. Some centers offer sliding scale fees or payment plans when you qualify. Treatment centers that accept federal block grants may have scholarships or grants that do not need to be repaid to cover the cost of treatment.

Crowdfunding or personal loans or friends and family may also help cover costs. You can also consider other low cost rehabilitation facilities such as county or state run programs or nonprofit faith based programs or a program like the Salvation Army that allows you to work instead of paying for treatment.

It’s important to know that not all programs offer the same level of quality care. Check the facility’s accreditation which indicates they met a national standard of care and make sure they are staffed by licensed professionals. You’ll also want to check online reviews. Not all online reviews are entirely accurate so it’s important to look at them as a whole rather than only one or two.