If you've faced long waits for VA appointments — or simply live too far from a VA facility — the MISSION Act of 2018 may entitle you to see a private doctor at VA's expense through the VA Community Care program. In 2025, with VA wait times at record levels in many regions, more eligible veterans are qualifying than ever before. This guide explains exactly how community care works, the specific eligibility thresholds, how to get a referral, and what to do if VA denies your request.
VA Community Care is a program under which the VA pays for veterans to receive healthcare from civilian, non-VA providers. Instead of treating a veteran at a VA medical center, the VA authorizes — and then pays for — treatment at a private clinic, hospital, or specialist's office in the community.
Community care is not a fallback or inferior option. For many veterans, a community care provider may be more accessible, more specialized, or simply faster to see. The VA pays the provider at Medicare-like rates, and the veteran pays standard VA copays (which are waived or reduced for veterans with service-connected conditions or low income).
The program is administered under 38 U.S.C. § 1703 (as amended by the MISSION Act) and VA's implementing regulations at 38 C.F.R. § 17.4100 et seq. The VA's Office of Community Care oversees the program nationally, with regional contractors (TriWest Healthcare Alliance in the west, Optum Public Sector Solutions in the east) handling provider networks and authorizations.
Community care is not new — VA has offered some form of non-VA care for decades. But the Veterans MISSION Act of 2018 (Public Law 115-182) was a landmark overhaul that replaced the previous Veterans Choice Program with a more accessible and comprehensive framework.
Key changes under the MISSION Act include:
The MISSION Act took full effect on June 6, 2019, replacing the Veterans Choice Program entirely. Veterans who were using Choice were automatically transitioned to the new Community Care program.
The MISSION Act established specific, objective standards for when a veteran is eligible for community care. You qualify if VA cannot meet these thresholds:
These standards are either/or — you only need to meet one. If the nearest VA that offers primary care is 35 minutes away, you qualify for community care primary care regardless of VA's current wait times. If the VA's next available orthopedic appointment is 35 days out, you qualify for community care specialty care regardless of how close the VA is.
Drive time is measured as straight-line driving time from your residence to the nearest VA medical facility that offers the needed service — not to the nearest VA clinic. If the nearest full-service VAMC is across a mountain range or requires a ferry, that travel time counts.
The VA's Access to Care website (accesstocare.va.gov) publishes real-time average wait times for VA facilities. You can look up your nearest facility and see current average days to next appointment for primary care, mental health, and specialty services. Screenshot this page if you intend to request community care — it documents your eligibility.
Beyond the drive-time and wait-time standards, the MISSION Act created a flexible "best medical interest" pathway for community care. Under this criterion, a veteran may be eligible for community care even when the objective time/distance standards are met, if any of the following apply:
The best medical interest criterion requires the involvement of a VA clinician. A VA primary care provider must document the clinical rationale for community care in the veteran's medical record. This is why establishing care at VA — even if you ultimately receive treatment in the community — is strategically important.
The process for requesting community care involves several steps, all of which must be completed in order:
Monday–Friday, 8 a.m.–6 p.m. local time. Ask about your eligibility, referrals, and authorizations.
This is the most important rule in the entire community care program: you cannot self-refer for community care. If you see a private doctor without first obtaining VA authorization, VA will not pay the bill — and you will be responsible for 100% of the cost.
This is not a technicality. The VA has consistently denied claims for unauthorized community care, and the amounts can be substantial. A single specialist visit can cost hundreds of dollars; a hospitalization can cost tens of thousands.
Never schedule a community care appointment until you have a written authorization from VA. Even if the VA staff member verbally tells you to "go ahead and schedule," do not proceed without written authorization. Verbal approvals are not binding — only written authorizations protect you from financial liability.
If you're in a situation where VA is slow to issue an authorization and your condition is deteriorating, escalate immediately: contact the Patient Advocacy office at your VA facility, call the MISSION Act Community Care line at 866-606-8198, and ask your VA primary care provider to flag the referral as urgent.
Community care can cover a wide range of healthcare services, including:
Services must be medically necessary and consistent with VA's clinical guidelines. The community care authorization specifies exactly what service(s) are authorized. If you need additional services beyond what was authorized, return to VA for an updated referral.
One of the most valuable MISSION Act provisions is the urgent care benefit: enrolled veterans who have been seen at VA at least once in the past 24 months can go to approved urgent care facilities without prior authorization.
Urgent care is appropriate for conditions that require attention within 24 hours but are not life-threatening emergencies. Examples include minor injuries, sudden illness, ear infections, urinary tract infections, and similar same-day conditions.
Key details about the urgent care benefit:
Urgent care and emergency care are different programs. If you have a life-threatening emergency, go to the nearest ER — VA's emergency care policy covers stabilization costs at non-VA ERs for eligible veterans, but you must notify VA within 72 hours of the emergency. Failure to notify VA can result in billing complications.
Not all private providers accept VA community care. Use the VA Community Care Provider Locator (find.va.gov) to search for VA-approved providers by specialty, location, and accepting-patient status. The database is updated regularly and shows which providers in your area are currently accepting VA community care patients.
You can also ask the VA's Community Care coordinator at your facility to provide a list of approved specialty providers in your area. When you contact a community provider, confirm:
If you have a specific specialist you prefer — for example, a doctor you've seen before your military service — check whether they are in the VA's community care network. If not, they can apply to join; VA actively needs providers in many specialties and regions.
VA may deny a community care request for several reasons: the facility claims your wait time is within standards, the drive time is calculated differently than expected, or the service is deemed available locally. Here's what you can do:
| Step | Action | Where to Go |
|---|---|---|
| 1 | Request a written denial with the specific reason | Your VA Community Care Coordinator |
| 2 | Document your actual wait time (screenshot accesstocare.va.gov) | Access to Care website |
| 3 | Ask your VA primary care provider to re-document the medical necessity | Your PACT team or primary provider |
| 4 | Contact the Patient Advocate at your VAMC | Ask at the VA front desk for Patient Advocacy |
| 5 | File a formal complaint with the VA Office of Inspector General | oig.va.gov hotline: 1-800-488-8244 |
| 6 | Contact your congressional representative for a congressional inquiry | House.gov or Senate.gov to find your rep |
Congressional inquiries are particularly effective. A letter from a congressional office to VA leadership typically produces a response within 30 days and often resolves access issues that have been stalled for months at the facility level.
VA wait times have become a persistent problem. In 2025, the VA's own access data shows that average wait times for primary care appointments exceed 20 days at many facilities — meaning a significant percentage of enrolled veterans technically qualify for community care for primary care today.
For specialty care, the picture is even more concerning. Orthopedics, neurology, cardiology, and mental health — all specialties with high demand from veterans — frequently have wait times well above the 28-day specialty care threshold in many regions.
Many veterans don't know they're eligible. They accept long waits as normal, unaware that the MISSION Act entitles them to community care when VA can't meet its own standards. If you are waiting more than 20 days for a primary care appointment or more than 28 days for specialty care, you should be requesting a community care referral immediately.
Veterans in rural areas are especially likely to qualify on drive-time standards. If you live in a rural county and the nearest full-service VA medical center is more than 30–60 minutes away, you likely qualify for community care for all services — regardless of wait times. Don't assume you need to make that drive.
If you're waiting weeks for care or living far from a VA facility, you may qualify for Community Care under the MISSION Act. Our tools help you understand your VA benefits and access options.
Explore Your VA Benefits →Sources: Veterans MISSION Act of 2018 (Pub. L. 115-182); 38 U.S.C. § 1703; 38 C.F.R. § 17.4100; VA Office of Community Care (va.gov/communitycare); VA Access to Care website (accesstocare.va.gov); VA Patient Rights and Responsibilities, VHA Directive 1010, updated 2024.