The VA’s Largest Community Care Administrator Has a Mental Health Problem
Veterans were promised quality options. Optum's clinic closures and provider shortfalls are failing them — and the VA is letting it happen.
By Russell Lemle, Senior Policy Analyst
Read Russell’s Feature in the HEALTH CARE un-covered Substack
For many veterans grappling with mental health issues, nothing beats sitting in the room with a therapist. Charlie Marg is one of them. His wife, Paige, testified to this last year at a Senate Committee on Veterans’ Affairs hearing examining treatment in the Community Care Network (CCN) — the VA’s backup pool of private-sector providers: “My husband has utilized telehealth before in some of his referrals to community care. Personally, he would rather choose to see somebody in person… especially when he’s talking about his mental health struggles.”
Charlie is far from alone in preferring a clinician who’s physically present over one on a screen. But a penetrating investigation published last month by HEALTH CARE un-covered suggests that choice may become harder to come by within the CCN — not because of policy changes, but because of decisions based on a corporate balance sheet.
The Optum contraction
The investigation traced UnitedHealth Group’s behavioral-health acquisitions from 2011 to 2025. Over that span, Optum — UnitedHealth’s sprawling health-services division and the CCN’s largest administrator — purchased 70 entities operating hundreds of behavioral-health offices, then completely or partially shut down half of them.
Meanwhile, Optum Ventures, the company’s venture capital arm, has poured more than $2 billion into 75-plus companies, nearly all of them virtual, digital, or data-driven platforms. As the report bluntly put it, the “labor-intensive, in-person clinics that patients depend on are closed in the name of ‘affordability’... a word that describes the company’s costs, not the patient’s.” Closures typically arrive with little advance notice and no warm handoff to another provider, leaving patients “to find their own way, sometimes toward virtual options by default because nothing else is offered.”
For example, in February 2026, Optum shuttered its Red Oak Counseling of Wisconsin. Patients were given three weeks’ notice with minimal information about treatment transfers and directed to a couple of generic referral sources, plus one concrete option: “Optum Behavioral Care’s virtual (‘telehealth’) therapy practice.“
In New Jersey, Optum informed its patients on November 3, 2025, that all its state behavioral-health services would be discontinued at month’s end: “We’ve made the difficult decision to no longer offer Behavioral Health services in New Jersey... After [Nov. 30], these clinicians will no longer be part of Optum Medical Care, and all scheduled appointments will be canceled.”
Harold Kudler, M.D., who served as national lead for VA Mental Health policy from 2014 to 2018, told HEALTH CARE un-covered that suddenly cutting off an established clinician-patient relationship could constitute patient abandonment: “Providing 14 to 30 days’ notice and a sufficient list of available, qualified clinicians would likely meet the minimum standard for medically stable patients. But when a clinician or healthcare system fails to provide any referrals at all or directs patients to clinicians who lack availability and/or the necessary competence, it raises serious ethical and legal questions. Patients with more severe mental health problems are especially vulnerable.” The American Psychiatric Association holds terminating clinicians responsible for giving patients reasonable notice, helping them find appropriate care, and continuing to provide treatment — including medication instructions — until the transfer is complete.
Optum’s medical entity is legally distinct from its CCN administrator role. Hoping to get a clearer picture of how the closures affected veterans, I asked an Optum spokesperson familiar with the company’s various business lines how many of its 100-plus shuttered clinics had furnished services through the CCN. She asked for time to look into it, and ten days later reported back that cross-checking was difficult — and couldn’t verify that any had, even after I told her I had evidence to the contrary.
I knew that to be the case because I’d called the number listed for Red Oak Counseling of Wisconsin, a practice that had featured veterans prominently in its marketing, and was automatically rerouted to an Optum representative. When I asked her whether the clinic had served veterans through the CCN before it shut down last February, she said that it had.
The North Carolina Center for Resiliency in Asheville, also acquired by Optum, remains open. A call to the office two weeks ago confirmed it was part of the CCN, but the only appointments currently available are telemental health, not in-person.
A CCN facility ran into trouble of a different kind earlier this year. Premier Wellness Healthcare in Bel Air, Maryland, was unexpectedly dropped from the network without formal notice, canceling appointments for veterans who relied on the clinic for psychotherapy and medication management. According to the clinic’s social worker, “It put a pause on all veterans where all of their care just abruptly stopped” for two and a half weeks, until a Voice for Veterans investigation prompted Optum to apologize for what it called a “technical error” and reinstate coverage.
A VA Office of Inspector General (OIG) report on community mental health care, released this week, found that both CCN third-party administrators, Optum and TriWest, are struggling to deliver timely care. Twenty percent of mental health referrals to the CCN in FY2025 failed to secure an initial appointment within 30 days of the consult being sent, and among those that missed the deadline, the average wait was 56 days — a level of compliance the VA classifies as “marginal performance.”
The report also flagged a structural problem with in-person access: most mental health providers in the CCN primarily or exclusively offer telehealth services. That imbalance creates a scheduling bottleneck, since veterans who want face-to-face care often find very few such CCN appointments available.
In-person options narrowing. Providers listed as available that aren’t. Quality of care that’s disregarded. Increasing privatization. That’s the real story of CCN’s mental health care.
Unreliable provider directories
The CCN provider directories aren’t dependable sources for who’s available to accept referrals.
A 2024 OIG audit looked at TriWest’s “underutilized provider” lists at the VA facility in San Antonio, covering behavioral health, ophthalmology, optometry, obstetrics/gynecology, and primary care. A scheduling supervisor called every provider on those lists. The result: 78% weren’t accepting VA patients, despite TriWest listing them as available. And even the providers who were taking VA patients weren’t necessarily a good fit. As the facility’s community care chief put it, they “may not be near the veterans in need of the service or may only conduct telehealth [emphasis added] appointments, which might not be an appropriate method of care.”
The OIG recommended that the VA “develop a process to make sure the third-party administrators regularly update their Community Care Network provider lists to reflect accurate provider contact information and annotate providers who are not currently accepting VA patients.” At the time, the VA dismissed that recommendation, stating that “TPAs are not contractually required to provide updates regarding providers that may not be currently seeing Veteran patients.” That position hasn’t changed. Current VA Press Secretary Quinn Slaven confirmed the administration has no plans to fix the underlying issue, noting that “every recommendation from the 2024 OIG report has been marked as implemented and closed.”
A veteran given the option for community care might still prefer a VA appointment if it were faster — but that comparison is impossible to make up front. For over a decade, the GAO has been recommending that the VA track and publish community care wait times the same way it already does for its own facilities. The VA has never done it.
Unverified competence
A referral to a CCN therapist doesn’t mean much without assurance about the quality of that care. The authors of the VA MISSION Act of 2018 clearly understood this — the word “quality” appears 50 times. The law required CCN mental health providers to be trained to assessment and treatment standards comparable to the VA’s, particularly in areas where the VA has “special expertise,” including PTSD, military sexual trauma (MST), and traumatic brain injury (TBI).
Instead, the VA made training voluntary. The results are exactly what you’d expect. A recent GAO report found that between 2021 and 2023, roughly 2% of CCN mental health clinicians had completed a single training module. More than 8,000 veterans flagged as active suicide risks during that period were referred to providers with no recorded training whatsoever in suicide prevention. Anxiety and stress-related disorders accounted for nearly half of the diagnoses in these referrals; almost none of the community providers treating them had documented PTSD or military sexual trauma training.
CCN clinicians are far less likely than VA providers to useevidence-based psychotherapies for PTSD, depression, and related conditions. VA providers are required to conduct annual screenings for suicide risk, PTSD, substance use, military sexual trauma, and depression. CCN mental health providers have no such mandate — 57% of them don’t routinely screen for the problems that show up disproportionately in veteran populations.
The VA has a pattern of deliberately turning a blind eye to CCN providers’ deficiencies — failing to check state databases before prescribing controlled substances, skipping core trainings, not forwarding initial and final medical documentation, and neglecting to report suicide attempts and deaths to the VA. In each instance, the VA has been explicit about its priority: a large CCN pool, regardless of the consequence of retaining flawed providers within it.
Paul M. Russo, FACHE, former executive director of the Bay Pines VA Health Care System, who retired in 2024, told HEALTH CARE un-covered, “Community care partners are an important adjunct to VA care. However, the importance of ensuring comparable, evidence-based behavioral healthcare was always a question as we had little evidence of the required training and lack of quality measures with the Optum third-party administrator.”
The VA’s hemorrhaging mental health workforce
All this is unfolding while the VA intentionally shrinks its own mental health staff, as demand continues to rise. Since January 2025, the department has eliminated 351 psychologist positions, 717 social worker positions, and approximately 200 psychiatrist positions from its rolls. The VA claimed the cuts were for “unfilled and unnecessary” positions, but left unsaid was why they remained vacant: most were purposely left frozen or stalled in protracted HR hiring lags, not because the need for them had waned. The VA Inspector General reported last year that psychologists were the most frequently reported severe clinical occupational shortage in the entire department.
What’s more, the VA isn’t done. Its recent budget submission signals further cuts ahead — and acknowledges that this will leave VHA unable to meet demand: “VHA is assuming that staffing levels will decrease, which is expected to reduce VHA capacity to provide for the growing demand for VA direct care services.”
And indeed, the need for care keeps climbing. Since 2021, over 700,000 veterans have been newly designated with a service-connected mental health disability, bringing the total to 3.1 million. GAO projects mental health appointment demand will rise 32% between 2021 and 2031. Yet the VA is shrinking its mental health workforce even as that demand grows — and referrals into CCN have surged in parallel, doubling between Fiscal Years 2021 and 2024.
A self-inflicted wound
Even the mechanism that decides who gets a referral to CCN in the first place is defective.
Charlie Marg’s preference for face-to-face appointments is just one side of the picture. Roughly half of VA mental health patients choose virtual care instead — typically because it spares them a drive to a medical center or clinic. Research supports its utility: video-delivered treatment performs as well as in-person care for most mental health conditions.
But the option to receive telehealth has a hidden problem. The MISSION Act instructs the VA to determine community care eligibility based on wait and drive times to a VA provider — but the VA’s calculation ignores whether a patient prefers telehealth or in-person care. The result is absurd: a veteran who wants telemental health and could get a fast appointment with a VA clinician is still officially counted as lacking “timely access,” and is offered the option of community telehealth or in-person care anyway. Former VA Secretary McDonough himself testified this was a mistake, one that needlessly diverts up to a billion dollars a year into the CCN. The prior and current administrations have had the power to plug this loophole and simply haven’t.
Congress could close it too, but instead is moving in the opposite direction. At a July 2025 House Committee on Veterans’ Affairs markup, Rep. Herb Conaway (D-NJ) offered a legislative amendment that would count a veteran’s chosen VA telehealth appointment as “access to care.” Chairman Mike Bost (R-IL) seemed to agree, stating: “It should always be the veteran’s choice to decide if that is right for them.” But he and fellow Republican committee members then voted the amendment down. They’ve since gone a step further. The Take Care of America’s Veterans Act, aggressively being pushed by Republicans this summer, contains a provision that would bar the VA from ever correcting the flaw. That would ensure money is gratuitously funneled to private-sector entities even when the VA could potentially provide telemental health more quickly than the CCN.
What needs to happen
The status quo — an underfunded VA workforce, an ever-widening but undertrained community network, and a for-profit contractor liquidating its in-person capacity — is unacceptable. Fixing it requires action on several fronts:
Staff the VA to capacity so veterans who prefer VA clinicians can get timely care in the manner they want.
Hold third-party administrators accountable so veterans who qualify for CCN receive prompt face-to-face or telemental health treatment they were promised.
Fix the telehealth exclusion so that both VA telehealth and VA in-person care are counted as “access” when determining community care eligibility.
Pass the Fostering TRUST Act, the Honor Act, and any legislation requiring CCN mental health providers to meet training standards equivalent to the VA’s own — not the voluntary regime currently in place. Alternatively, include those requirements in VA’s upcoming “Next Generation” CCN contracts.
Include behavioral health in CCN’s “High Performing Provider“ designations. Optum and TriWest gauge which providers in their network meet High Performing Provider criteria. But behavioral health providers are explicitly exempt. Veterans scheduling a CCN mental health appointment deserve to know which providers meet a quality bar — and which don’t.
The point isn’t whether veterans should have access to private-sector mental health care when the VA can’t deliver it quickly or near enough. They should.
But right now, three counterproductive forces are working against them at once: a VA reducing its own workforce, a Congress and VA indifferent to community provider proficiency, and a for-profit contractor shuttering mental health practices.
None of this is inevitable. Every unfilled psychologist billet, every undertrained CCN clinician, every closed CCN clinic reflects a choice — and choices can be revised. The only real question is whether VA and Congressional leaders will treat veterans’ access to quality mental health care as the obligation it is.
Russell Lemle, PhD, is a Senior Policy Analyst at the Veterans Healthcare Policy Institute and former Chief Psychologist at the San Francisco VA Healthcare System.
