VA Community Care Explained

What VA Community Care Is

Under the Veterans Community Care Program, VA pays a non-VA (community) provider to treat a veteran when VA cannot provide the needed care itself, in a reasonable amount of time, or close enough to home. It is a fallback built into VA's own health system, not a separate program a veteran can pick freely instead of VA care. The program is set out in 38 U.S.C. § 1703 and 38 CFR §§ 17.4010 and 17.4040, and was created by the MISSION Act of 2018 (the Maintaining Internal Systems and Strengthening Integrated Outside Networks Act).

The Eligibility Rules

Two baseline requirements apply to everyone, and at least one of six additional criteria must also be met.

Baseline requirements (both apply)

• VA health enrollment: the veteran is enrolled in VA health care, or is eligible for it.
• Prior approval: the veteran's VA health care team approves the community care before the visit. (This approval step is waived for the separate urgent care benefit and for true emergencies, both covered below.)

Plus at least one of these six criteria (38 CFR § 17.4010(a)(1)-(6))

• No VA service: VA does not offer the needed service at any VA medical facility.
• No full-service facility in-state: VA does not operate a full-service VA medical facility in the veteran's state of residence.
• Grandfathered under the 2014 rule: the veteran lives in Alaska, Montana, North Dakota, South Dakota, or Wyoming, qualified under the 2014 Veterans Choice Act's 40-mile rule as of June 5, 2018, and still lives there. (A related branch of this rule, for veterans in other states who received care between June 6, 2017 and June 6, 2018 and sought care before June 6, 2020, has since expired and no longer applies.)
• Access standards not met: VA cannot schedule the veteran within the drive-time and wait-time standards described below.
• Best medical interest: the veteran and the referring VA clinician agree that community care serves the veteran's best medical interest. Factors that may be weighed include distance to the VA facility, the type of care needed, how often the veteran needs it, how soon a VA appointment is available, the potential for better continuity of care, quality of care, or an unusual burden on the veteran, such as excessive driving distance, a geographic obstacle like a body of water or difficult terrain, hazardous weather or traffic, a medical condition that limits travel, another compelling reason, or the need for an attendant to travel with the veteran.
• Quality standards not met: the VA medical service line that would provide the care does not meet VA's own quality standards.

Two additional duties apply once a veteran is using community care: report any other health care plan or insurance to VA before getting authorized community care, and notify VA within 60 days of any change of address or change in other health coverage.

The Access Standards

One of the six criteria above, "access standards not met," is measured against two published targets. VA calculates drive time using geographic information system (GIS) mapping software.

If VA cannot schedule the veteran within both the drive-time and the wait-time standard for the applicable type of care, that failure is itself one of the six qualifying criteria for community care. This page reports the published standard; it does not estimate any individual veteran's actual drive time or wait time.

How the Referral and Authorization Process Works

Outside of urgent and emergency care (covered in their own sections below), community care runs through a referral and authorization process. A "referral" here means the VA health care team formally requests, or "consults," on the veteran's behalf for outside care. An "authorization" is VA's written approval letting a specific community provider treat the veteran for a specific, limited scope of care.

For ongoing or recurring care, once an authorization is in place the veteran can schedule repeat visits directly with the community provider's office, but only up to what that authorization allows. Going beyond it requires a new referral, or reauthorization.

Urgent Care: A Separate, Simpler Benefit

Urgent care is its own VA benefit, distinct from the referral process above. No referral and no prior authorization are needed.

• Eligibility: enrolled in VA health care, and has received care from VA or from an in-network provider sometime in the last 24 months.
• What it covers: minor, non-life-threatening issues such as strep throat, pink eye, sprained muscles, and skin or ear infections, plus basic diagnostics like X-rays and lab tests. It is not a substitute for primary or preventive care.
• Life-threatening situations: call 911 or go to the nearest emergency room instead of using the urgent care benefit.
• Cost at the visit: nothing is due at the time of the visit. A copay of up to $30 may apply afterward, depending on priority group and how often the veteran has used the benefit. VA bills the veteran later; the veteran never pays the provider directly.
• Prescriptions: a community provider's prescription can be filled for up to a 14-day supply (7 days for opioids, or a shorter state limit if one applies) at a VA pharmacy at no cost, at an in-network pharmacy at no cost, or at an out-of-network pharmacy if the veteran pays first and files for reimbursement. Longer or non-urgent prescriptions go through the veteran's local VA pharmacy.

Emergency Care

• 72-hour notification: for VA to coordinate and potentially pay for the care, VA must be notified within 72 hours of the emergency care starting. The provider, the veteran, or someone acting on the veteran's behalf can provide that notification.
• Missing the window: missing the 72-hour notification does not automatically mean the claim is denied, but it shifts the claim to the stricter standard that applies to unauthorized emergency care, which generally requires a service-connected condition or a permanent and total disability rating.
• Other insurance: VA cannot reimburse copays charged by a veteran's other health insurance. If that insurance does not fully cover the bill, VA may cover the remaining amount, but only up to what the insurer would normally have paid, not amounts denied because of a missed deadline or an unfiled claim.

How Billing and Copays Work

For authorized community care, the veteran never pays the community provider directly. The provider bills VA, or a Third-Party Administrator that manages the community provider network and processes claims on VA's behalf. If the veteran owes a copay, VA bills the veteran directly afterward, as a separate bill.

If a provider asks for payment at the visit

Do not pay a community provider at the time of an authorized visit. VA does not require payment at check-in, even for a copay: any copay owed is billed by VA afterward, separately. If a provider's office asks for payment upfront, show the VA authorization letter and tell the office VA authorized the visit. Then report it to the VA Community Care Contact Center (below) so VA can follow up with the provider.

If the provider bills the veteran instead of VA

A community provider in VA's network agreed, by contract, to bill VA or the Third-Party Administrator for authorized care, not the veteran. If a bill or collections notice arrives directly from the provider instead of VA:

• Keep the paperwork: save the bill, notice, or collection letter.
• Call the VA Community Care Contact Center: 877-881-7618, Monday through Friday, 8 a.m. to 9 p.m. Eastern time. VA staff take down the details, look into the claim, and follow up with the outcome.
• Ask for it in writing: the veteran can request a letter confirming whether VA accepts responsibility for the bill.
• If it is a VA copay bill, not a provider bill: dispute it in writing within 30 days to avoid late fees. Submit the dispute online, through Ask VA, or by mail to the local VA medical center's business office marked "Billing dispute." A dispute VA receives within 90 days pauses collection action while it works through the dispute.

How strong this protection is depends on the type of visit. For urgent care (38 CFR § 17.4600) and emergency care (38 CFR § 17.1008, titled "Balance billing prohibited"), federal regulation states that VA's payment is payment in full and the provider cannot legally charge the veteran anything more. For standard, referral-based community care, that same rule is not written into the regulation the same way; the no-direct-billing practice instead comes from the provider's network contract with VA. Report a bill from a referral-based visit right away using the contacts above.

Community Care vs. CHAMPVA

Community Care and CHAMPVA are easy to confuse because both involve VA paying for care outside VA facilities, but they serve different people.

See the full CHAMPVA guide for eligibility details and how to apply.

Where This Program Came From: The Veterans Choice Program (2014-2018)

Today's Community Care Program replaced an earlier, temporary program called the Veterans Choice Program, created by the Veterans Access, Choice, and Accountability Act of 2014 (Pub. L. 113-146) after a wait-time scandal at VA facilities.

• Eligibility under Choice: enrolled by August 1, 2014 (or newly eligible for VA care), plus at least one of: could not get a VA appointment within a 30-day wait-time goal; lived more than 40 miles from the nearest VA facility; lived in a state with no VA hospital, emergency room, and standard-complexity surgical care, and more than 20 miles from one; or lived within 40 miles of a facility but had to travel there by air, boat, or ferry, or faced a serious geographic burden reaching it.
• The Choice Card: eligible veterans received a physical "Veterans Choice Card," issued within 90 days, an ID card rather than a guarantee of benefits.
• How copays worked then: under the Choice Program, the veteran paid any copay directly to the outside provider at the time of the visit. Today's Community Care Program instead bills the veteran afterward through VA, so the veteran never pays the community provider directly.
• Why it ended: the Choice Program was temporary by design, funded by a one-time $10 billion Veterans Choice Fund. Its authority expired when that fund ran out or three years after enactment, whichever came first, around August 2017. Congress passed the permanent MISSION Act in 2018 to replace it with the Community Care Program described on this page.

What Changed Recently

As of August 2025, 30 standardized specialty types of care, including cardiology, dermatology, endocrinology, gastroenterology, mental health outpatient, nephrology, oncology and hematology, optometry, orthopedic care, pain management, podiatry, pulmonary, physical medicine and rehabilitation, rheumatology, sleep medicine, and urology, now receive a full 12-month standing authorization instead of the previous 90-to-180-day reauthorization cycle. This reduces how often veterans with ongoing specialty care needs have to be re-approved.

Frequently Asked Questions

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