VA Community Care: Accessing Healthcare Outside the VA

Welcome, Veterans! At United for the People, we believe in empowering you with the knowledge and resources to access the best possible healthcare. A crucial program for many veterans is VA Community Care, which allows you to receive healthcare services from non-VA providers in your local community. This can be a vital option when VA facilities are not readily available or cannot meet your specific needs.

This page will help you understand the eligibility, the process for accessing care, and key resources for Community Care.

What is VA Community Care?

VA Community Care allows eligible Veterans to receive medical care from community-based providers, paid for by VA, when VA cannot provide the care. This expands your access to a wider network of healthcare options closer to home.

Eligibility for Community Care

You must be eligible for VA health care benefits to receive Community Care. Beyond that, you may be eligible for Community Care if you meet at least one of the following criteria:

  1. Lack of Full-Service VA Facility: You need a specific service that is not available at any VA medical facility.
  2. Long Wait Times: The VA cannot provide an appointment for you within VA facilities that meets VA’s wait-time standards.
  3. Excessive Drive Time: Your drive time to the nearest VA medical facility or VA-contracted provider is unreasonable based on VA’s access standards. This generally applies if:
    • For primary care or mental health care, your drive time to a VA facility is 30 minutes or more.
    • For specialty care, your drive time to a VA facility is 60 minutes or more.
  4. Best Medical Interest: Your VA provider determines it is in your best medical interest to receive care from a community provider. This could be due to complex medical conditions, the need for specialized equipment, or other clinical reasons.
  5. VA Service Line Not Meeting Standards: The VA facility where you receive care has a specific service line that is not meeting certain quality or access standards.
  6. “Grandfathered” Eligibility: You meet specific criteria under previous community care programs (e.g., Choice Program) that allow you to continue receiving community care.

Important: Your eligibility for Community Care is determined by your VA care team.

The Process for Accessing Community Care

It’s important to follow the correct steps to ensure your Community Care appointments are covered by the VA. Do NOT schedule your own appointments with community providers unless explicitly instructed by the VA.

  1. Discuss with Your VA Provider:

    • The first step is always to discuss your healthcare needs with your VA primary care provider or specialist.
    • Explain why you believe Community Care would be beneficial (e.g., long drive, specific service needed, wait times).
    • Your VA provider will initiate the referral process if they determine you meet eligibility criteria.

  2. VA Makes Referral & Authorization:

    • If approved, your VA care team will submit a referral request to the VA Community Care office.
    • The Community Care office will then verify your eligibility and authorize the care.
    • Crucially, you must have an authorized referral before you receive care from a community provider for VA to cover the costs.

  3. Scheduling Your Appointment:

    • Once authorized, you may be contacted by:
      • VA staff: They may schedule the appointment for you.
      • A third-party administrator: Such as TriWest Healthcare Alliance or Optum Public Sector Solutions, who contract with the VA to arrange appointments.
      • The community provider directly: They may call you to schedule.
    • Ensure you receive confirmation of the scheduled appointment.

  4. Receiving Care:

    • Attend your appointment with the community provider.
    • The community provider will send your medical records back to the VA after your appointment, ensuring your VA team has a complete picture of your care.

  5. Prescriptions & Follow-Up:

    • Community providers can write prescriptions. These should typically be filled at VA pharmacies or through their network. Confirm with your VA care team for specific guidance.
    • Follow up with your VA provider after your Community Care appointment to discuss your treatment plan and any further needs.

Important Reminders:

  • Always work with your VA care team. They are your gateway to Community Care.
  • Never self-authorize care. Without VA authorization, you could be responsible for the full cost of community care.
  • Keep your VA informed. Ensure your VA provider receives updates and records from your community care appointments.

VA Community Care Resources

For more detailed information, eligibility rules, and program updates, please visit the official VA website:

If you have questions about your eligibility or an existing referral, you can contact the VA Community Care program directly:

  • VA Community Care Phone Number: 1-877-881-7618

At United for the People, we’re here to help you navigate your VA benefits. We hope this information empowers you to make the most of your healthcare options.