Community Care & the MISSION Act

What Is VA Community Care?

Community care allows eligible veterans to receive health care from approved providers outside the VA medical system — at the VA's expense. Under the VA MISSION Act (2018), the VA established clear eligibility criteria and access standards for when veterans can seek care in the community.

This isn't a replacement for VA care. It's an option when the VA can't deliver the care you need within acceptable timeframes or distances.

When You Qualify for Community Care

You're eligible if any of these apply:

1. Service Not Available at the VA

The VA doesn't offer the specific care you need at any VA facility.

2. Access Standards Not Met

The VA can't schedule your appointment within:

• 20 minutes average drive time for primary care, mental health, or non-institutional extended care
• 60 minutes average drive time for specialty care
• 20 days for primary care or mental health appointments (from date of request)
• 28 days for specialty care (from date of request)

3. Grandfathered Access

You were eligible under the previous Veterans Choice Program and continue to meet similar criteria.

4. Best Medical Interest

Your VA provider determines that receiving care from a community provider is in your best medical interest.

5. VA Service Standard Gaps

A VA medical service line doesn't meet quality standards set by the VA.

6. State Without a Full-Service VA Medical Center

If you live in a state or territory without a full-service VA medical facility.

How to Get Community Care

Step 1: Get a Referral

Community care requires a referral (except for urgent care — see below). Here's how:

1. Contact your VA primary care team or specialty care provider
2. Request community care based on one of the eligibility criteria above
3. The VA reviews your request and checks whether the care can be provided within access standards
4. If approved, you receive a referral authorization

Step 2: Choose an Approved Provider

The VA uses third-party networks to manage community care:

• Optum and TriWest Healthcare Alliance manage the networks in different regions
• Use the VA's provider locator to find approved community providers
• You can also request a specific provider — the VA will verify they're part of the network

Step 3: Schedule Your Appointment

• In some cases, the community care network will contact you to schedule
• In others, you'll schedule directly with the community provider
• Bring your referral authorization to the appointment

Step 4: VA Pays the Provider

• The provider bills the VA (or the network), not you
• You should not receive a bill for approved community care
• If you do receive a bill, contact the VA immediately — do not pay it yourself

Urgent Care Benefit

The MISSION Act includes an urgent care benefit that doesn't require a referral:

• Available to veterans enrolled in VA health care
• Visit any VA-approved urgent care provider in the network
• Copay may apply (typically $30 for the first 3 visits per year, then $60)
• Covers urgent care, not emergency care (emergencies have separate rules)

Find approved urgent care locations at VA.gov/find-locations.

What's Covered

Community care covers the same services the VA provides:

• Primary care
• Specialty care (cardiology, orthopedics, neurology, etc.)
• Mental health care
• Physical therapy and rehabilitation
• Diagnostic testing (imaging, labs)
• Maternity care for eligible veterans
• Some dental care (if you have VA dental eligibility)

What's Not Covered

• Services not clinically indicated (cosmetic procedures, etc.)
• Providers not in the approved network (unless specifically authorized)
• Over-the-counter medications
• Services already denied by the VA on clinical grounds

Prescriptions Through Community Care

If a community provider prescribes medication:

• First fill — the community provider can prescribe through a local pharmacy (VA pays)
• Ongoing prescriptions — should be transferred to the VA pharmacy for fulfillment (saves the VA money and you get medications through the VA mail pharmacy or at a VA facility)

Common Issues and How to Resolve Them

You Received a Bill

If a community provider bills you for authorized care:

1. Do not pay it — the VA is responsible for authorized community care
2. Call the VA community care line at 1-877-881-7618
3. Provide your authorization number and the bill details
4. The VA will work with the provider to resolve it

Long Wait for Authorization

If the VA is slow to process your community care request:

1. Contact your VA Patient Advocate
2. Call the community care phone line
3. If eligible under access standards, cite the specific wait time or drive time standard that isn't being met

Provider Not in Network

If you have a preferred provider who isn't in the VA's network:

1. Ask the VA if they can be added (one-time or ongoing authorization)
2. Alternatively, ask the provider if they'll enroll in the VA's community care network
3. Some providers don't participate because of VA reimbursement rates — this is, unfortunately, common in some specialties

Important: Keep VA in the Loop

Even when receiving community care, the VA remains your primary coordinator. Always:

• Ensure records from community care visits are sent to the VA
• Follow up with your VA primary care team after community appointments
• Use the VA for prescriptions whenever possible
• Report any problems with community providers to the VA