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Mission Act Failing Us As Veterans

Hello! It's been quite some time since I have posted anything. I have been dealing with an immense amount of pain dealing with a pump that was placed to help with one thing causes something else to be wrong, it's never ending.

I wanted to talk about the Mission Act, which I have touched on in prior posts. The above picture shows VA hospitals across the country. Gives a good view of how far apart some VA facilities are from one another. I mention this because 9 out of 10 patients will be told they will be sent to the next closest VA for whatever reason. This is one of the exact things the Mission Act should help, not to mention several other ways. There are so many veterans that don't even know how the Mission Act works. If you already know then feel free to scroll past the criteria I will list:

VA Community Care Requirements

If you are a veteran and are interested in community care benefits, you should know that eligibility for VA community care depends on individual needs and other factors including the requirements below as published by the VA official site:

  • Veterans must receive approval from VA before using healthcare from a community provider.

  • Veterans must either be enrolled in VA health care or be eligible for VA care without needing to enroll to be eligible for community care.

  • VA staff members generally make all eligibility determinations.

  • Veterans will usually have the option to receive care at a VA medical facility regardless of their community care options.

General Eligibility Rules For VA Community Care

The Veteran Needs a Service Not Available at a VA Facility

On a case-by-case basis, veterans may be eligible to be treated in the community when the VA does not have in-house options for a certain kind of approved treatment.

The Veteran Lives In An Area Without a Full-Service VA Medical Facility

There are a variety of areas where a veteran may qualify for community care because there is no full-service VA facility available within a reasonable distance. These areas include, but may not be limited to, Alaska, Hawaii, New Hampshire, and the U.S. territories of Guam, American Samoa, the Northern Mariana Islands, and the U.S. Virgin Islands.

The Veteran Is Eligible For The “Grandfather” Provision

Two VA requirements must be met to be considered under the “Grandfather Provision”:

  • The veteran was eligible under the 40-mile criterion under the Veterans Choice Program on the day before the VA MISSION Act was enacted into law (June 6, 2018).

  • The veteran continues to reside in a qualifying location.

If BOTH conditions are met, eligibility would be determined if one of the following apply:

  • The veteran lives in one of the five States with the lowest population density from the 2010 Census: North Dakota, South Dakota, Montana, Alaska, and Wyoming.

  • The Veteran lives in another State and received care between June 6, 2017, and June 6, 2018, and requires medical care before June 6, 2020.

The VA Cannot Furnish Care Meeting Certain Standards

There are VA standards for “average drive times” and “appointment wait-times.” These standards are under review and subject to change due to legislation, alteration of program guidelines, or other variables.

At the time of this writing the criteria included certain drive times to a specific VA medical facility of 30 minutes for primary care and certain other services and a 60-minute drive time for specialty care.

Appointment wait time standards are similarly subject to change, but in general the following standards apply at the time of this writing:

  • 20 days for primary care

  • 20 days for mental health care

  • 20 days for non-institutional extended care services, unless the Veteran agrees to a later date in consultation with their VA health care provider

  • 28 days for specialty care from the date of request, unless the Veteran agrees to a later date in consultation with their VA health care provider

Other VA Community Care Eligibility Rules

Situations Where Community Care Is In The Veteran’s Best Medical Interest

On a case-by-case basis, a veteran may be referred to a community healthcare provider when the patient and the referring doctor or agency agree that it is in the patient’s best interests to get care in the community.

Situations Where A VA Medical Service Does Not Meet Quality Standards

There may be instances where the Department of Veterans Affairs notes that a medical service line “is not meeting VA’s standards for quality based on specific conditions” and in such cases the VA Mission Act allows veterans to opt for care from a community provider, though the VA advises this is possible, “with certain limitations.”

My significant other and I have both experienced the Mission Act pros and cons. When my partner had to have brain surgery in 2019, our VA wasn't even a choice due to it not having a neurosurgery department. So instead of sending him through community care to see the local neurosurgeon from Albany Medical Center (which by the way our VA is partnered with and allows their students to practice on vets), he was sent to the "closet VAMC", which was 3.5 hrs away! We tried to get a referral into community care but was denied, even though we were at a hardship. By hardship I mean the drive/distance, the surgery/recovery, and a driver to drive him home/followup appt(I don't drive due to medical issues). These were just a few reasons that should have been in our favor for community care. Needless to say we had to figure it all out. There were the trips made for an initial appointment with neurosurgery. At neither of the two appointments did he even meet the doctor doing his surgery, it was the doctor's nurse practitioner. I'm sorry but with a surgery as scary as this, I'd think that a doctor would at least stop in to introduce themselves. He met the doctor 5 minutes before going under and didn't find out until much later that he didn't even do the surgery! It was a freaking resident! He was kept for 24 hours in ICU after the surgery then he was released. Then came the drive home. It was horrible. The guy just had brain surgery 24 hours prior. They didn't offer any type of neck brace or anything. I had to go to the VA PX and buy a pillow. When we had a medical emergency due to surgery that VA told us we had to drive back to them because there were no neurosurgeons at ours. The whole situation was just horrible. Then to top it off when they offered Physical Therapy after a few weeks of healing, they set it up for our VA. So PT was also a fiasco. They gave us a pamphlet of exercises to do at home and some curved massage bar that prosthetics had to it 2 weeks later.

Now fast forward to my first neurosurgical appointment. My doctor that the consult came from works at Albany Med and our VA. Is it a coincidence that his consult stated to send me to Albany Med Neurosurgery Dept? I will add that my consult and his consult weren't that far apart. So it wasn't like we had years in between being sent to neurosurgery.

Appointment wait time is another big one that isn't followed per the guidelines. The wait for appointments is well over 30 days and the Mission Act states anything over a 20 day wait is eligible for community care. That's not even counting things like mental health. We wait 6 to 8 months for appointments. When an established veteran needs mental health services yet can't in to see a provider for 6 to 8 months, that's one of the reasons veteran suicides are so high. Note: I said one of the reasons because there are several other ones that could be changed to help those in crisis.

So to wrap things up, there are so many veterans that get shafted from the loopholes with the Mission Act. We have experienced it firsthand. The difference now is we know the routes to take when it comes to getting community care so that we don't get caught in those loopholes. We have to right to speak up and challenge something that was supposed to help veterans not make it harder on them.

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