In 2018, the VA MISSION Act was signed into law, creating a new veteran program designed to expand access to community healthcare options. The MISSION Act, also known as the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018, ended the previous Veterans Choice Program.
But in July of 2024, a group of lawmakers is taking the VA to task over what they believe are indicators that the Department of Veterans Affairs wants to walk back portions of the VA Mission Act. Why?
The lawmakers claim that the VA’s position essentially includes the idea that veterans getting in-community care poses an “existential threat” to the VA in general and that referrals to community care for those in the VA system should be limited.
The open letter sent to the VA Secretary alleges that the VA wants to lower the number of referrals for community-based medical care outside the VA system, but the VA has not at press time formally implemented such measures. The open letter also takes the VA to task for allegedly denying community care access for a number of veterans.
According to the open letter, “VA must embrace both the spirit and letter of that transformational piece of legislation to ensure this does not continue…”
Related: Disabled Veteran Benefit Guide
An Open Letter to the Department of Veterans Affairs
The open letter to the VA Secretary includes mention of so-called Red Team studies the VA has done on community care costs. The open letter alleges selective data was used to drive the VA’s results of the study to a specific end.
“VA leaders…” the letter says, provided the Red Team ”select data and briefings” the open letter claims, “that contributed to the conclusion that frames community care as a potential existential threat to VA’s direct care system, rather than the vital lifeline it is for veterans and for VA…”
The VA Red Team Report
A Department of Veterans Affairs report on the community care issue includes this quote addressing the issue of community care:
“Referring Veterans enrolled in the Veterans Affairs (VA) Health System to non-VA providers (aka ‘community care’ or ‘out of network care’) is an important strategy for serving Veterans when needed services are not readily available in VA’s direct care system.”
However, the report continues, “costs of such referrals have risen dramatically in recent years (to nearly $30 billion in FY 2023) and may now threaten funding needed to support VA’s direct care system.”
The bottom line according to that report? Members of the committee that authored it were ”in unanimous agreement that VA urgently needs to take action to control community care utilization and spending if the direct care system is to continue to be available to serve the diverse, specialized, and often highly complicated health care needs of enrolled Veterans…”
The MISSION ACT
The MISSION Act program, which became operational in 2019, was intended to “strengthen the nationwide VA Health Care System by empowering Veterans with more health care options” according to the VA official site..
“The changes not only improve our ability to provide the health care Veterans need, but also when and where they need it,” according to then-VA Secretary Robert Wilkie, who is quoted in a press release on the VA official site.
Wilke noted,. “It will also put Veterans at the center of their care and offer options, including expanded telehealth and urgent care, so they can find the balance in the system that is right for them.”
Related: Disabled Veteran Benefit Guide
How MISSION Act Community Care Works
Under the replacement Veterans Community Care Program under the MISSION Act, “Veterans can work with their VA health care provider or other VA staff to see if they are eligible to receive community care based on new criteria.
Eligibility for community care does not require a Veteran to receive that care in the community; Veterans can still choose to have VA provide their care.”
According to the VA, the MISSION Act criteria grants a veteran access to community care if:
- The veteran cannot get a primary or mental health care appointment within 20 days.
- The timeline for a specialty care appointment is more than 28 days.
- The location of a veteran’s primary or mental health care appointment is more than a 30-minute drive.
- Specialty care appointments require a drive longer than 60 minutes.
- The VA doesn’t have the services a veteran needs.
- Community care is in the best interest of the veteran.
At the time of this writing no 2024 alterations to VA policy regarding community care were forthcoming. This is a developing story.
Related: Disabled Veteran Benefit Guide