Eligibility For Community Care Outside VA
VA Community Care — Getting Care Outside the VA
As a Veteran, you may be eligible to receive care outside the VA through the VA Community Care Network. This means the Department of Veterans Affairs may authorize and pay for care from an approved, in-network community provider.
⚠️ Important: You can always choose to receive care at a VA health facility instead.
You can:
• Find an in-network community provider
• Learn how to request community care
• Use the VA website search bar if you can’t find what you need
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Eligibility Requirements for VA Community Care
To receive VA Community Care, both of the following must be true:
• You are enrolled in (or eligible for) VA health care
• You receive approval from your VA health care team before care
(except in certain urgent or emergency situations)
In addition, at least ONE of the following must apply:
• The VA does not provide the service you need
• You live in a state or territory without a full-service VA facility
• You and your VA provider agree community care is in your best medical interest
• The VA cannot provide care that meets quality standards
• You qualified under the 40-mile distance rule as of June 6, 2018 (certain states)
• The VA cannot provide care within drive time or wait time standards
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Designated VA Access Standards
Primary Care, Mental Health & Extended Outpatient Care
• 30-minute average drive time OR
• 20-day wait time
Specialty Care
• 60-minute average drive time OR
• 28-day wait time
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Examples of When You May Qualify for Community Care
Example 1: A Service the VA Does Not Provide
You need maternity care or in vitro fertilization (IVF). These services are not provided at VA facilities, so you may receive care from an in-network community provider.
Example 2: No Full-Service VA Facility
You live in Alaska, Hawaii, New Hampshire, Guam, American Samoa, the Northern Mariana Islands, or the U.S. Virgin Islands. Because there is no full-service VA facility, you may qualify for community care.
Example 3: 40-Mile Distance Qualification
You qualified under the Veterans Choice Program’s 40-mile rule as of June 6, 2018 and live in Alaska, Montana, North Dakota, South Dakota, or Wyoming. You may still qualify under these rules.
Example 4: Drive Time or Wait Time Standards
Primary Care or Mental Health
• Average drive time exceeds 30 minutes, or
• Earliest appointment is more than 20 days away
Specialty Care
• Earliest appointment is more than 28 days away, or
• Drive time exceeds 60 minutes
Example 5: Best Medical Interest
You require recurring treatment and medical conditions make travel difficult, or you need ongoing care that cannot be delivered timely by the VA. If you and your VA provider agree it’s medically appropriate, community care may be authorized.
Example 6: Quality Standards
The VA determines that your local VA facility cannot provide care that meets quality standards (such as cardiology services). Community care may be approved.
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Referrals & Scheduling
• VA must approve community care before services are received
• Referrals are coordinated by your VA health care team
• Scheduling is arranged through the VA or its contractors
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If VA Denies Your Community Care Request
How to Appeal
If your request is denied, you may file a Clinical Appeal.
• The VA facility’s Chief Medical Officer (or designee) reviews the appeal
• Relevant medical records are considered
• Decisions are based on VA medical policy and eligibility
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Important Information & Disclosure
Anthony’s Healthcare provides educational information to help Veterans understand VA Community Care and related eligibility rules. We are not affiliated with or endorsed by the U.S. Department of Veterans Affairs (VA), Medicare, or any government agency.
VA Community Care eligibility, authorization, referrals, provider selection, scheduling, appeals, and payment decisions are determined solely by the U.S. Department of Veterans Affairs based on federal law, VA policy, and individual medical circumstances. Prior VA approval is generally required for community care, except in certain urgent or emergency situations.
Information provided on this page is for educational purposes only and does not guarantee eligibility, authorization, coverage, payment, or access to community care services. Veterans should rely on the VA for official determinations, referrals, and appeal decisions.