What Is VA Community Care?

VA Community Care allows eligible veterans to receive health care from non-VA providers in their local community, paid for by the Department of Veterans Affairs. The program was significantly expanded by the VA MISSION Act of 2018 (Public Law 115-182), which replaced and consolidated earlier programs including the Veterans Choice Program.

Under the MISSION Act, the VA can authorize community care when the veteran meets specific eligibility criteria — most commonly when the VA cannot provide the needed care within certain wait times or drive-time standards, or when community care is in the veteran's best medical interest.

Community Care is not a separate insurance plan. It is a referral-based system: your VA provider must determine that you meet the criteria and submit the authorization request on your behalf.

Who Is Eligible Under the MISSION Act?

Any veteran enrolled in VA health care may be eligible for Community Care if at least one of six qualifying conditions is met. You do not need a service-connected disability rating to qualify — enrollment in VA health care is the baseline requirement.

According to the VA's official Community Care page, the eligibility framework is designed to ensure veterans receive timely, appropriate care whether inside or outside the VA system.

The Six Eligibility Conditions

The MISSION Act defines six specific conditions under which a veteran may receive Community Care. At least one must be met:

1. The VA doesn't offer the service you need. If the VA facility does not provide the specific medical service, procedure, or specialty care required, you may be referred to a community provider.
2. The VA facility is not feasibly available. This applies when the nearest VA facility is too far away or when geographic barriers (such as living on tribal lands or in a U.S. territory) make accessing VA care impractical.
3. The VA cannot meet access standards. As of the MISSION Act's access standards, if the VA cannot schedule an appointment within 20 days for primary care, mental health, or non-institutional extended care services (or 28 days for specialty care), you may qualify for community care.
4. Drive-time standards are not met. If the nearest VA facility with the required capability is more than a 30-minute average drive for primary/mental health care or a 60-minute average drive for specialty care, you may be eligible.
5. Community care is in your best medical interest. Your VA provider may determine that, based on your specific medical condition, receiving care in the community would be safer or more effective. This is a clinical judgment call made by your VA care team.
6. The VA service line quality is inadequate. If the VA's own quality standards for a particular service line are not met (for example, based on comparative quality metrics), community care may be authorized.

Practical note: In practice, conditions 3 (wait times) and 4 (drive times) are the most commonly cited reasons for Community Care referrals. If you've been told your next available VA appointment is weeks away, ask your provider whether you qualify under the access standards.

How to Request a Community Care Referral

You cannot self-refer to Community Care. The process starts with your VA care team. Here is the typical workflow:

1. Talk to your VA primary care provider or specialist. Explain the care you need and why you believe community care may be appropriate (long wait times, distance, etc.).
2. Your provider submits a consult. If your provider agrees you meet the criteria, they enter a Community Care consult in the VA's electronic health record system.
3. The VA's Office of Community Care reviews the request. A Community Care representative evaluates the consult against the six eligibility conditions.
4. You receive a decision. If approved, you'll be contacted by a VA-contracted third-party administrator (TPA) — currently TriWest Healthcare Alliance or Optum depending on your region — to schedule your community appointment.
5. Attend your appointment. The community provider bills the VA directly. You should not receive a bill for authorized Community Care services.

Tip: If your VA provider is hesitant to submit a consult, you have the right to ask for a clear explanation of why. You can also contact the VA's Community Care office directly at 877-881-7618 or visit your VA medical center's Community Care office in person.

What Happens After Your Referral Is Approved

Once your Community Care referral is authorized, here's what to expect:

• You'll be assigned a third-party administrator (TPA). The TPA will help you find an in-network community provider and schedule your appointment.
• Your VA provider sends medical records. The VA is required to share relevant medical records with the community provider to ensure continuity of care.
• The community provider treats you and reports back. After your appointment, the community provider sends a report and any test results back to your VA care team.
• Follow-up care returns to the VA. Community Care is typically authorized for a specific episode of care. Ongoing or follow-up treatment usually returns to the VA unless a new authorization is issued.

Important: Do not schedule your own community appointment and expect the VA to pay for it. Unauthorized care — care received without a VA referral and authorization — is generally not covered and you may be responsible for the full cost.

If Your Community Care Request Is Denied

If your Community Care consult is denied, you have options:

1. Ask for the reason in writing. The VA must provide a written explanation for the denial, including which eligibility criteria were not met.
2. Request a clinical review. You can ask for a review by a VA clinician who was not involved in the original decision.
3. File a patient advocate complaint. Every VA medical center has a Patient Advocate office. They can help you navigate the appeals process and advocate on your behalf.
4. Contact the Veterans Crisis Line if urgent. If your health is at risk and you cannot get timely care, call 988 and press 1 for the Veterans Crisis Line, or go to the nearest emergency room.

A denial does not mean you have no recourse. Many denials are overturned on review, especially when the veteran or their advocate provides additional documentation supporting the need for community care.

Common Mistakes Veterans Make

Based on reports from veteran service organizations and VA patient advocates, these are the most frequent errors veterans encounter with Community Care:

• Assuming enrollment equals automatic access. Being enrolled in VA health care is necessary but not sufficient. You must meet one of the six eligibility conditions.
• Waiting too long to ask. If you know your VA appointment is months away, raise the issue early. The sooner the consult is submitted, the sooner you can be seen.
• Not documenting wait times and drive times. Keep records of your VA appointment offers, including dates and distances. This documentation supports your case if a dispute arises.
• Seeing a community provider without authorization. As noted above, unauthorized care is typically not covered. Always get the VA's approval first.
• Not following up on the referral. After your provider submits the consult, follow up with the Community Care office to ensure it's being processed. Bureaucratic delays happen.

Key Resources

• VA Community Care — Official Program Page
• Am I Eligible for Community Care?
• VA MISSION Act of 2018 — Full Text (S.2372)
• VA Community Care hotline: 877-881-7618
• Patient Advocate: Available at every VA medical center — ask at the front desk
• Veterans Crisis Line: Call 988, press 1

Frequently Asked Questions

Do I need a service-connected disability to use Community Care?

No. Any veteran enrolled in VA health care may be eligible if one of the six qualifying conditions is met. Your disability rating is not a factor in Community Care eligibility.

Can I choose my own community provider?

The VA-contracted TPA will help you find an in-network provider. You can express preferences, but the provider must be in the VA's community care network for the VA to cover the cost.

Will I have to pay copayments for Community Care?

Copayment rules for Community Care mirror VA copayment rules. Veterans with a service-connected rating of 50% or higher, or those receiving care for a service-connected condition, typically have no copayment. Other veterans may owe copayments based on their priority group and the type of service.

How long does a Community Care authorization last?

Authorizations are typically issued for a specific episode of care or a set number of visits. If you need additional care beyond the original authorization, your VA provider must submit a new or extended consult.

What if I live in a rural area far from any VA facility?

Veterans in rural areas often qualify under the drive-time standard (30-minute average drive for primary care, 60-minute for specialty care). The VA also has specific programs for highly rural veterans — ask your VA care team about the Veterans Transportation Program and telehealth options as alternatives.