Stop Congress From Weakening Veteran Suicide Prevention

This week, as the nation pauses to honor our veterans, Congress may pull a fast one on them.

House leaders are weighing a floor vote on the Take Care of America’s Veterans Act (TCAVA), a sprawling package of 60 bills. Its frontal assault on veterans’ disability benefits has drawn fierce criticism. Barely noticed are two grant programs tucked inside it: the Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program, a pilot program that the legislation would extend, and a new mental health grant program called the RECOVER Act. Together, they could strip the Department of Veterans Affairs (VA) of its power to decide when veterans get outside care, and of the VA’s ability to coordinate that care once it is delivered. That would erode the foundation of how the VA works, and veterans who rely on the VA would pay the price.

The Cornerstone That Has Held

For nearly two decades, private-sector interests have pressed the VA to send more veterans to outside providers. The Choice Act of 2014 opened the door, and the MISSION Act of 2018 widened it, steadily loosening the rules for who qualifies for what is called “community care.” Today, about a third of the VA’s health care budget pays for care from a network of 1.7 million private providers.

Through all of it, one indispensable safeguard has held: The VA decides which veterans qualify for care delivered outside its walls, a role the MISSION Act explicitly preserved. That gatekeeping authority does three jobs at once. It gives the VA oversight to monitor, to the extent possible, the quality of care that veterans get. It informs VA clinicians about which of their patients are being treated elsewhere, so their care can be coordinated. And it lets the VA exercise the kind of utilization review that is routine in the private sector. It provides a fiscally prudent check on how the VA spends its finite budget, so that it has enough money to deliver care in its own hospitals and clinics.

Head-on efforts to remove that authority have consistently been stalled. Sen. Marsha Blackburn’s Veterans Health Care Freedom Act, which would let veterans bypass VA authorization, has been introduced three times since 2022 without becoming law.

The two grant programs in TCAVA, however, could succeed where she has not.

Back Door #1: The Fox Grant Program

A sound idea. The Fox program began with true bipartisan agreement. In 2019, the veteran suicide rate was stuck: An average of 17 veterans took their lives each day, ten of them with no connection to VA care. Sens. Mark Warner (D-VA) and John Boozman (R-AR) joined Reps. Jack Bergman (R-MI) and Chrissy Houlahan (D-PA) to design grants for community organizations already embedded in veterans’ lives. The hope was that those groups could reach veterans before a crisis, offer case management, benefits help, and other nonclinical services, and steer those who need mental health care to the VA. The program is named for Staff Sergeant Parker Gordon Fox, a 25-year-old Army sniper instructor who died by suicide in 2020.

The law’s real innovation was the promise that renewal of a grant would depend on demonstrated results. “We must have a common tool to measure the effectiveness of our programs,” Boozman said. Warner was blunt that simply counting the number of veterans served was not enough. Grantees were to assess five risk factors at entry and exit: suicidal ideation, mental health status, mental well-being, financial stability, and social support. As the VA itself put it, “Having this screening occur at the beginning and prior to services ending is important in evaluating the effectiveness of the services provided.”

A bright line. The rules on clinical care are unambiguous. Fox grants “cannot be used to fund treatment for mental health or substance use disorders, except for clinical services for emergency treatment.” Additional care for mental or behavioral health conditions must be referred to the VA. The VA’s regulations add that “any ongoing clinical services provided to such individuals by the grantee are at the expense of the grantee,” even when a veteran declines VA care.

That boundary exists for good reason. Fox was built to do what the VA can’t easily do on its own: find at-risk veterans, especially those not enrolled in the VA, bring them into care, and offer nonclinical support that reduces their suicide risk. It was never meant to duplicate the mental health care the VA and its Veterans Community Care Program already provide, or to sidestep the VA’s authority over outside care.

VA Secretary Collins Is Wrong About Veteran Suicide Prevention Funding

A line being crossed. Fifty-six of the program’s 191 grantees for fiscal year 2027 are in the business of providing routine mental and behavioral health treatment. That makes it all too easy to blur the line between emergency and routine care.

The Prospect called six grantees whose websites list clinical services, asked for the person overseeing their Fox program, and posed two questions: Do you provide routine mental health care to Fox veterans, whether after an emergency or from the start? And if so, who pays? All six said it was routine for them to provide in-house, non-emergency therapy. Three weren’t sure how their organizations paid for that care. The other three said their Fox grant covers all or part of it. That is inspector general territory.

The VA is supposed to prevent this from happening. Its Office of Business Oversight (OBO) audits Fox grantees to “obtain reasonable assurance that transactions are completed in compliance with SSG Fox SPGP and Federal requirements and that Federal assets are adequately safeguarded.” The audits aren’t made public, but the Prospect obtained one of them. It shows how little these reviews are designed to find. Grant money paying for routine therapy would surface only if an auditor happened to sample the right clinical transactions and recognized them as non-emergency treatment. I asked one of the grantees specifically about their OBO review, and they responded, “We had small portion of our clinical director and therapist on Fox budget at one point and it was not flagged in audits.”

The Prospect filed a Freedom of Information Act request for records showing whether, and how, the VA verifies that grant funds are not paying for routine care. When the VA didn’t respond, the Prospect put the question to VA press secretary Quinn Slaven. He declined to answer.

According to the VA’s congressionally mandated report covering the program’s first two and a half years, grantees made 8,461 non-emergency mental health referrals. The report conspicuously omits where those veterans were sent. A source with direct knowledge told the Prospect that referrals to non-VA mental health providers are commonplace, a departure from the law’s intent.

Judged by what Congress meant it to be, Fox falls short.

To be clear, the report documented some genuine good, notably 755 emergency mental health referrals for participants showing signs of imminent risk of suicide.

In all, 8,373 people completed a Fox intake and received at least one service or referral. That sounds like a lot—until you consider that two-thirds of grantees enrolled fewer than one new participant a week, on average. The program also largely missed the population it was built for, those Bergman called “veterans who are outside the VA system of care.” Eighty-three percent of veterans admitted to Fox were already enrolled in the VA.

The report offered plenty of background data on each grantee’s participants, from demographics to military history, but nothing on the question that matters most: whether individual grantees reduced suicide risk. Without grantee-level results, policymakers, veterans, and the public can’t tell effective grantees from the rest, or know whether ones with no demonstrated impact win renewal anyway.

Most of that data needed to judge the program is simply missing. Every participant is required to get a baseline screening, yet 21 percent never did. Eighty percent have no before-and-after data, so no one knows whether the services left them better, worse, or unchanged. Among the roughly 1 in 5 who were assessed both times, more than 80 percent improved on at least one measure. That deserves credit, but it describes a small slice of participants, not the program as a whole.

When deciding renewals, the VA’s rules also require it to weigh whether “the cost per participant was reasonable.” The report’s numbers suggest otherwise. Divide each three-year grantee’s total award by its number of participants, and for 75 percent of grantees the cost tops $10,000 per participant. For a quarter, it exceeds $30,000, a figure that strains any reasonable definition of cost-effectiveness. (Both figures are adjusted for the fact that participant counts covered only two and a half of the three grant years.) Yet most grantees spending that much were renewed anyway. One likely reason is that the VA doesn’t appear to do this simple math. Its renewal application instead lets grantees supply their own estimate, which captures only part of their expenses. The Prospect’s FOIA request for the scoring sheets the VA used to judge renewals has gone unanswered.

None of these failings stopped the VA from recently doubling the program’s funding. In March 2025, VA Secretary Doug Collins questioned whether the department’s suicide prevention budget was being spent effectively and floated a change: “maybe redirect that $588 million to suicide prevention programs that are working.” Three months later, at a Senate hearing, he signaled what he had in mind: “We’re rethinking prevention, reaching beyond VA, and using every tool we’ve got, including the Fox Grant Program, to save lives.”

This year, he followed through. In September, the VA announced $111.9 million in new Fox grants, $59 million more than the yearly awards in the program’s first four rounds. Congress never approved those extra millions. The money came out of other VA suicide prevention initiatives, programs with a stronger track record than Fox.

The VA has promoted the expansion by claiming that “more than 90%” of participants who complete services report improvement in at least one of four areas. That figure counts only the small share of participants with before-and-after measures, and improving on one of four is a low bar. The announcement said nothing about whether Fox reduces suicide risk itself. Nor does the VA track suicide deaths among participants, though they were a focus of the 2020 law. The VA’s own evaluation calls estimating that impact “not feasible.” Meanwhile, the VA’s annual suicide report offers related context: Among veterans not enrolled in the VA, the very population Fox is paid to reach, the suicide rate rose 3.7 percent from 2023 to 2024. Among VA enrollees, it fell 4.8 percent.

Rigorous measurement matters all the more because the VA is funding organizations that provide services with no evident connection to suicide prevention, such as helping veterans buy and grow an established business, and craniosacral therapy, a technique of light touch to the skull, spine, and sacrum.

At an April 2025 Senate hearing, Sen. Tommy Tuberville (R-AL) asked how the VA could “stop the bad actors from taking these grants away from people [who] actually need these grants.” Even a Fox grantee testifying that day conceded that “if there is oversight, it’s not transparent.” Congress has nonetheless kept extending Fox without adding meaningful accountability.

Back Door #2: The RECOVER Act

Meanwhile, several of the same grantees are trying to push open a second door. For nearly a decade, the Cohen Veterans Network (CVN) and its allies have sought to rewrite the rules of veterans’ mental health care: steering VA dollars to nonprofit providers and stripping the VA of its role in deciding when veterans may seek treatment outside its walls. RECOVER would do both.

Steven A. Cohen pivoted to veterans’ causes after his hedge fund, SAC Capital, pleaded guilty to insider trading in 2013 and paid a $1.8 billion penalty. In 2016, he founded CVN, which has since grown to 23 outpatient clinics serving post-9/11 veterans and their families. Most sit within 15 miles of a VA facility. That proximity mattered. Under the Choice Act’s distance criterion, veterans qualified for VA-paid private care only if they lived more than 40 miles from a VA facility.

Cohen’s response was to try to change the rules. With former House Veterans’ Affairs Committee Chairman Jeff Miller as his lobbyist, he pushed to end the VA’s advance approval for private mental health care, so a veteran could walk into a CVN clinic and the VA would simply pay. Veterans service organizations closed ranks against it, warning of the danger of dropping the VA’s authorization role. The proposal died.

A Billionaire Tries Again to Hijack Veterans’ Care

The idea resurfaced, however, in August 2024, when House Veterans’ Affairs Committee Chairman Mike Bost (R-IL) introduced the Veterans’ Mental Health Access Act. He reintroduced it in 2025 as the RECOVER Act. The bill is a sweetheart deal. It would create a three-year, $60 million VA pilot program awarding grants of up to $1.5 million per facility per year to nonprofit outpatient mental health clinics. Most of the likely recipients already treat veterans on the VA’s dime. No VA referral would be required. It would open a third channel of care, alongside the VA and the Veterans Community Care Program, largely beyond the VA’s reach. RECOVER has since been folded into TCAVA, which may be back on the House floor this month.

CVN has openly championed the bill. Sen. Blackburn’s March press release on the Senate version quoted CVN directly: The legislation “would establish a pilot grant program to support non-profit clinics like CVN.” In a statement for the House hearing, CVN argued that “bureaucratic red tape” should not stand between veterans and timely care. Yet its clinics already treat veterans whom the VA refers through the Veterans Community Care Program. What CVN wants is to push the VA out of the authorization process altogether, reducing it to a grant-maker, and one step closer to being a mere insurance payer.

The Same Players, Both Doors

The Fox program and RECOVER share more than a grant-making design. They share potential beneficiaries.

Aspire Health Partners, which runs CVN’s Tampa clinic, received $1.14 million in Fox grants in the program’s first two years. Aspire submitted a statement supporting RECOVER, arguing it would “ease the strain on VA systems,” apparently overlooking that easing that strain is precisely what the Veterans Community Care Program is for.

Endeavors, which runs Cohen clinics in San Antonio, El Paso, and now Mililani, Hawaii, has held Fox grants for Puerto Rico in three of the program’s five rounds. It also filed a statement backing RECOVER. Child and Family Service, another Fox grantee, formerly ran CVN’s Hawaii clinic.

Then there’s Centerstone Military Services, a Fox grantee in 2026 and 2027. It is an arm of Centerstone, which calls itself the “largest nonprofit behavioral health organization in the United States.” Its military program delivers care nationwide, in person and by telehealth, through a network of more than 1,500 clinicians. Centerstone also operates five Cohen clinics. In 2025, it spent at least $170,000 lobbying on veterans issues, including RECOVER. Its statement for the January House hearing framed the bill as a response to veteran suicide and argued that grants to nonprofits like itself would “reduce the overburden on VA facilities.” Overlooked was that diverting money to outside grantees would starve the VA of resources it needs to fix the mental health staffing shortages that create that burden in the first place.

Wounded Warrior Project (WWP), arguably the country’s largest veterans charity, is a major customer of Centerstone Military Services. According to WWP’s tax filings, it paid the organization $8.9 million for mental and brain health services over fiscal years 2023 through 2025. That’s roughly $3 million a year, more than half of Centerstone Military Services’ annual program revenue. WWP also gave $1.2 million to CVN over the same period. And WWP went further than any of them, urging Congress to fold RECOVER’s clinic grants into the Fox program itself.

Cohen’s and WWP’s support for veterans is laudable. But there must be a bright line between privately funded mental health services and the VA’s appropriations. Government dollars shouldn’t backfill philanthropy, and every federal suicide prevention and mental health dollar is needed for VA programs with a track record of reducing suicidal urges, attempts, and deaths.

What’s Lost When the VA Is Bypassed

Whether through undetected Fox spending or RECOVER grants openly awarded, the damage is the same. The VA loses its role as the authorizer, referrer, and overseer of care. A veteran could get therapy from a grantee even when a nearby VA medical center, clinic, or Vet Center could see them promptly. In many cases, the grantee could have provided the very same treatment through the VA’s community care program, with the VA’s authorization. Grantees aren’t required to send treatment records to the VA, however, so VA clinicians can’t coordinate care they don’t know about. Grantees face none of the peer review the VA requires of its own clinicians. The Fox program requires no training in suicide prevention, an astonishing omission for a program whose purpose is preventing suicide. All of this is an end run around the MISSION Act, which Congress wrote to create a single, coordinated system of VA and community care, with clear rules for when veterans can be sent to private providers.

Supporters of RECOVER say the grants fill access gaps, especially in underserved areas. But veterans who can’t get timely VA care already have a remedy: Under the MISSION Act, those facing long drives or waits qualify for community care.

A Path Forward

Fox needs to be fixed. RECOVER needs to be stopped. As Congress weighs TCAVA, five steps should be nonnegotiable.

First, pull the plug on the RECOVER Act, which could hand millions to well-funded nonprofit clinics, most already paid by the VA through community care, to run an outside lane with no VA referral and no record sharing. That doesn’t strengthen the VA; it splinters it.

Second, enforce the ban on grant-funded treatment. Audit every Fox grantee that provided mental health care in 2026 to determine whether grant dollars paid for it. Those that used Fox money for routine treatment should lose their renewal. Congress should ask the VA’s inspector general to investigate.

Third, no data: no renewal. Every participant gets the entry and exit assessments. Grantees that skip them don’t get renewed.

Fourth, pay for results. Enforce the VA’s own rules tying renewal to reduced risk at a reasonable cost per veteran.

Fifth, stop raiding the VA’s suicide prevention. Doubling Fox’s budget without evidence that it works was indefensible. If Congress wants more nonclinical suicide prevention, it should appropriate new money, not drain VA programs with a stronger record.

The idea behind Fox—reach veterans before a crisis and lives can be saved—deserves support. A program that funds organizations without making them show they reduce veterans’ risk does not. Neither does a new lane of care that bypasses the VA’s authority and weakens the system veterans depend on. This Veterans Day, the best way to honor those who protected us all is to protect the system built to care for them.