WHAT IS VA COMMUNITY CARE?
The VA provides health care for Veterans from providers in your local community outside of VA. Veterans may be eligible to receive care from a community provider when VA cannot provide the care needed. This care is provided on behalf of and paid for by VA for service connected conditions. As with care provided directly by VA, Veterans are charged a copayment for nonservice-connected care. Learn how to pay your bill and alternative payment options. In addition, VA may bill Veterans’ health insurance for medical care, supplies, and prescriptions related to treatment of nonservice-connected conditions.
Community care is available to Veterans based on certain conditions and eligibility requirements, and in consideration of a Veteran’s specific needs and circumstances. Community care MUST be first authorized by VA before a Veteran can receive care from a community provider.
In some cases, VA offers health care and services for a Veteran’s family members and dependents (beneficiaries) based on certain conditions and eligibility requirements. VA serves more than 360,000 beneficiaries through its family member and dependent health care benefit programs.
WHAT ARE THE 6 ELIGIBLITY CRITERA THAT CAN QUALIFY A VETERAN TO RECEIVE COMMUNITY CARE?
There are 6 criteria that can qualify a Veteran to receive community care. Veterans only need to meet one of these criteria to be eligible.
Criteria #1)You need a service not available at a VA medical facility:
This includes Veterans that need a specific type of care or service that the VA does not provide in-house at any of its medical facilities.
Criteria #2)You live in a State or U.S. Territory without a full-service VA medical facility: This includes Veterans that live in a U.S. state or territory that does not have a full-service VA medical facility such as: Alaska, Hawaii, New Hampshire, Guam, American Samoa, Northern Mariana Islands, U.S. Virgin Islands
Criteria #3)You qualify under the “grandfather” provision related to distance eligibility for VCP. This includes Veterans that live in one of the five states with the lowest population density from a U.S. Census:
North Dakota, South Dakota, Montana, Alaska, and Wyoming.
Criteria #4)The VA cannot provide care with certain designated access standards. If the VA is unable to schedule an appointment that is within a 30-minute average drive time for primary care, mental health, and non-institutional extended care services (including adult day health care) or a 60-minute average drive time for specialty care.
Criteria #5)It is in the Veterans BEST medical interest. A Veteran may be referred to a community provider when the Veteran and the referring clinician agree that it is in the best medical interest to see a community provider.
Criteria #6)The VA Service Line does not meet certain medical standards. If the VA has identified a medical service line is not meeting VA’s standards for quality based on specific conditions, Veterans can elect to receive care from a community provider under certain limitations.
HOW DO I SCHEDULE A COMMUNITY CARE APPOINTMENT?
Before scheduling an appointment, it is important for the Veteran to confirm with a VA staff member that they are eligible and authorized for community care. Once authorized to receive community care, the veteran can get a referral to a community care facility. VA will send the Veteran and the selected community provider a referral. VA will also send the Veteran’s medical documentation to the community provider to ensure proper care coordination between their VA care team and the community provider.
WHO CAN I CONTACT?
For questions or assistance, contact the VA Community Care Department at 1-877-881-7618 (option 1) Monday- Friday 8am-9pm EST