VA Community Care (MISSION Act) Guide

VA Community Care allows eligible veterans enrolled in VA healthcare to receive medical services from approved providers outside the VA system when the VA cannot provide timely, accessible, or adequate care. It is not a separate health plan — it is part of your VA healthcare benefit.

The program was significantly expanded under the VA MISSION Act (Maintaining Internal Systems and Strengthening Integrated Outside Networks Act), signed into law on June 6, 2018. The MISSION Act replaced and consolidated the earlier Veterans Choice Program and other community care authorities into a single, streamlined framework.

You must be enrolled in VA healthcare to be eligible for community care. If enrolled, you may receive community care if you meet any one of the following six conditions:

Community care is a referral-based program. Here is the general process:

• Step 1: You or your VA provider identifies a need for care that may qualify for community care under one of the six criteria above.
• Step 2: Your VA provider submits a community care referral. The VA reviews your eligibility based on the access standards and other criteria.
• Step 3: If approved, the VA issues an authorization for community care. You may be contacted by a VA community care coordinator or by a third-party administrator (such as Optum or TriWest, depending on your region).
• Step 4: You select a community provider from the VA's approved network of community providers. The VA or its contractor can help you find providers in your area.
• Step 5: You receive care from the community provider. The provider bills the VA directly — you should not receive a bill except for any applicable VA copays.
• Step 6: After your appointment, the community provider sends records back to the VA so your care remains coordinated within the VA system.

The MISSION Act created a separate urgent care benefit that does not require a VA referral:

• Enrolled veterans can visit an in-network urgent care provider for minor injuries and illnesses without getting prior VA approval.
• You are eligible for 3 urgent care visits per calendar year at no copay (for veterans in Priority Groups 1 through 5). Veterans in Priority Groups 6 through 8 may owe a copay starting with the first visit.
• After 3 visits in a calendar year, a copay applies for each additional visit.
• Urgent care covers treatment for conditions like sprains, minor cuts, cold and flu symptoms, minor infections, and similar non-emergency issues.
• For emergencies (chest pain, severe bleeding, difficulty breathing, etc.), go to the nearest emergency room — do not use urgent care.

To find an in-network urgent care location near you, use the VA facility locator and select "Urgent care" as the facility type.

There are several ways to initiate a community care request:

• Talk to your VA provider. During an appointment, tell your VA primary care provider or specialist that you would like to explore community care. They can initiate the referral process.
• Call your VA medical center. Contact the community care office or patient advocate at your local VA facility. They can explain your options and help start the referral.
• Use My HealtheVet or VA.gov. You can send a secure message to your VA care team through My HealtheVet to request information about community care eligibility.
• Contact the VA community care contractor in your region. Optum serves VA regions in the eastern United States, and TriWest serves western regions. They can provide information about approved community providers in your area.

Once the VA approves your referral, you generally have the option to choose between receiving care at a VA facility or from a community provider. The VA will present both options, and the decision is ultimately yours.

Your community care copays are the same as your VA copays. You do not pay more for receiving care in the community versus at a VA facility:

• Priority Groups 1–5: Generally no copays for most services.
• Priority Group 6: No copays for service-connected conditions; copays may apply for other care.
• Priority Groups 7–8: Standard VA copay rates apply.
• Service-connected conditions: Always free, regardless of priority group or whether care is at the VA or in the community.

• You MUST get VA approval first. Except for the urgent care benefit and true emergencies, you must have VA authorization before receiving community care. If you see a community provider without authorization, the VA may not pay the bill, and you could be personally responsible for the costs.
• Billing issues are common. Community providers sometimes do not understand the VA billing process and may send you a bill by mistake. If you receive a bill for VA-authorized community care, do not pay it. Contact your VA community care office and provide the provider with your authorization information. The VA pays the provider directly.
• Keep copies of all referrals and authorizations. Bring a copy of your VA authorization letter to every community care appointment. This helps the provider bill the VA correctly and protects you if billing issues arise.
• Authorizations have expiration dates. Your community care authorization is valid for a specific period and number of visits. If you need additional care beyond what was authorized, you will need a new referral from the VA.
• Prescriptions from community providers. If a community provider prescribes medication, you can often have it filled at a VA pharmacy (which may be less expensive). Ask the provider to send the prescription to your VA facility.
• Follow-up care coordination. After seeing a community provider, make sure the provider sends your medical records back to the VA. This keeps your VA care team informed and ensures continuity of care. If records are not sent automatically, you may need to request this yourself.
• Emergency care at non-VA facilities. If you go to a non-VA emergency room, notify the VA within 72 hours. The VA may cover emergency care at non-VA facilities under certain conditions, but timely notification is critical.

• VA Community Care — Official VA Community Care page with program information and resources
• Community Care Eligibility — Detailed breakdown of the six eligibility criteria
• VA Facility Locator — Find VA facilities and in-network community care providers, including urgent care locations
• VA Urgent Care Benefit — Information on the urgent care benefit, including how to find in-network providers
• VA MISSION Act Information — Overview of the MISSION Act and its impact on VA healthcare
• VA Health Benefits Hotline: 1-877-222-8387 (1-877-222-VETS), Monday through Friday, 8:00 a.m. to 8:00 p.m. ET