VA Community Care — See Outside Doctors

When and how to get VA-covered care from non-VA providers

Overview
What Is VA Community Care?
MISSION Act 2018

VA Community Care allows veterans to receive healthcare from non-VA (community) providers — and have the VA pay for it. This is not a workaround or a fallback; it's a legal right established by the VA MISSION Act of 2018, which dramatically expanded veterans' ability to choose where they receive care.

Before the MISSION Act, accessing outside care was complicated and restricted. Today, if you meet certain distance or wait-time criteria, the VA is required to authorize care from community providers — at the same copay you'd pay at a VA facility.

Despite this, most eligible veterans don't use Community Care because they don't know they qualify. This guide will help you understand your eligibility and how to use it.

Do You Qualify for Community Care?

You qualify if ANY of the criteria below apply. Answer the questions to see your eligibility.

📍 Distance Criteria

You qualify if there's no VA primary care within 30 minutes of your home, or no VA specialty care within 60 minutes.

⏱️ Wait Time Criteria

You qualify if the VA cannot schedule your appointment within 20 days (primary/mental health) or 28 days (specialty care).

🏥 Access & Quality Criteria

You may qualify if the VA doesn't offer the service you need, or if your VA provider determines it's in your best medical interest to receive care in the community.

✅ You Likely Qualify for Community Care

Based on your answers, you appear to meet the eligibility criteria. Here's what to do next: contact your VA primary care provider and request a Community Care referral. Mention the specific criteria that apply to you (distance over 30 min, wait time over 20 days, etc.). The VA is required to process your request.

🔍 Eligibility Unclear — Check with Your VA

Based on your answers, you may or may not qualify. Contact your VA facility's Community Care coordinator to assess your specific situation. Even if distance and wait times don't apply, the VA may authorize Community Care if it determines it's in your best medical interest.

Step by Step
How to Use Community Care
Once you're eligible, using Community Care is straightforward — but you must follow the process to avoid unexpected bills.
1
Talk to your VA primary care provider Request a Community Care referral at your next appointment. Explain why you qualify — distance, wait time, or service not available. Your VA provider initiates the process by submitting a referral.
2
VA contacts an approved community provider The VA (through Optum or TriWest) will contact a community provider in their network. You can request a specific provider — the VA will try to honor your preference as long as the provider is in-network and accepts VA patients.
3
Receive your care See the approved provider. Bring your VA authorization letter (or ensure the provider has received it). Do not see a provider for Community Care without prior authorization — except in emergencies.
4
Provider bills the VA directly The community provider sends the bill to the VA's third-party administrator (Optum/TriWest), not to you. Your only responsibility is your standard VA copay, which is the same as what you'd pay at a VA facility for your priority group.
Provider Network
The VA Community Care Network (CCN)
The VA contracts with two regional administrators to manage its nationwide Community Care Network.

Optum Serve

Regions 1, 2, 3 (East & Midwest)

Serves the eastern two-thirds of the US, including all states east of the Mississippi, plus some central states. Manages provider contracting, authorizations, and billing for the VA CCN.

TriWest Healthcare Alliance

Regions 4, 5 (West & Pacific)

Serves the western US including California, Texas, and the Pacific region. If your doctor is in the TriWest region, they work with TriWest for VA authorizations and billing.

Check if your doctor participates in the CCN: VA Facility Locator →

Emergency Care
Emergency Community Care

🚨 In a True Emergency, Go to the Nearest ER

VA covers emergency care at non-VA facilities when all of the following are true:

  • The condition is life, limb, or eyesight threatening
  • You could not reasonably reach a VA facility in time
  • A VA facility was not feasibly available

Critical: You must notify the VA within 72 hours of receiving emergency care for coverage to apply. Call 1-866-606-8198 to report emergency care. Failure to notify within 72 hours may result in you being billed for the full cost.

FAQ
Common Questions About Community Care
Yes — for most non-emergency care, you need a referral (called an authorization) from your VA primary care provider. Emergency care is the exception: go to the nearest ER and notify VA within 72 hours. Without prior authorization, the VA may deny payment and you could be responsible for the full bill.
Yes, you can request a specific community provider, and the VA will try to accommodate your preference. The provider must be in the VA Community Care Network (CCN), either through Optum or TriWest, and must be willing to accept VA patients and the VA's fee schedule. If your preferred provider isn't in the network, they can apply to join.
If you receive a bill for authorized community care, do not pay it — the VA should pay the provider directly. Contact the VA Community Care billing team at 1-866-606-8198. Your only responsibility is the standard VA copay for your priority group. If you receive a bill in error, the VA will work to resolve it with the provider.
Yes. Community Care covers mental health services including therapy, counseling, and psychiatry. The 20-day wait-time standard applies to mental health primary care as well. Veterans can also access the Veterans Crisis Line (dial 988, then press 1) and same-day mental health services at VA facilities, regardless of Community Care eligibility.

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