YOUR GUIDE TO USING THE VA COMMUNITY CARE NETWORK


By bblouin
VA community care stethoscope and a heart.

If you're eligible for VA healthcare but find that the services you need are not available in your area, you need to know about the VA Community Care program. Available to some Veterans, there are resources available that can help them receive the healthcare they deserve. Below, we're breaking down how the program works, who covers the costs, and more.

What Is VA Community Care?

VA Community Care is available to help Vets receive healthcare in places where the VA is unable to provide proper care by utilizing providers that can. While the healthcare services are provided on behalf of the VA, eligibility varies within the Veteran community. While the VA covers the VA Community Care network, copays may still be present.

Healthcare Services Available

Veterans have many different healthcare needs and fortunately, the program provides a variety of services to meet them. Here are the healthcare options available through the network:

  • Emergency care
  • Foreign medical care
  • Free flu shots
  • Home/hospice care
  • In vitro fertilization
  • Indian/Tribal healthcare
  • Primary care
  • State Veterans Homes
  • Urgent care

Eligibility

To be eligible for the VA Community Care program, you’ll need to meet one of the following criteria, in addition to being a Veteran:

  • You need healthcare not available at the VA.
  • You live in a state or territory that does not have a full-service VA healthcare facility, including Alaska, American Samoa, Guam, Hawaii, New Hampshire, Northern Mariana Islands, and the U.S. Virgin Islands.
  • You are grandfathered into eligibility due to the previous under-40-mile criteria before June 6, 2018, and you still live at that location. Furthermore, additional geographical criteria along with qualifying healthcare within certain time periods may be necessary for eligibility.
  • You must meet the average drive and wait times for the closest facility offering the healthcare service you require. For primary care, mental health needs, and non-institutional extended care, the drive time average is 30 minutes with a wait time of 20 days (unless otherwise agreed to) while the average is 60 minutes drive time for specialty care with a wait time of 28 days.
  • Both you and a referring clinician believe a community provider would be the best course of action for your health.
  • You need healthcare from a VA medical service line but the VA determines it’s not meeting the organization’s quality standards.

Once the VA determines that you are eligible for the program, an appointment is scheduled and you can receive healthcare. Billing takes place after services are provided.

Billing

If you are receiving non-service-connected healthcare, you may have copays, However, you can use health insurance to cover your costs. For Vets with financial hardships, alternative copays are available. Furthermore, if you have medical debt connected to COVID-19, you may be able to find relief through the VA Community Care network.

What Year Did the VA Start Community Care?

The program has roots in the early 1920s when such healthcare initiatives were initially for “exceptional cases” under the World War Veterans Act. Subsequent legislation expanded this to include various types of care for Veterans with and without service-connected disabilities, resulting in complex eligibility requirements. In response to public outrage over alleged wait time manipulation at the Phoenix VA, the Veterans Choice Act of 2014 established the temporary Veterans Choice Program. This would allow eligible Veterans to access community care at VA expense, with about one-third of VA-enrolled Veterans participating. The 2018 VA MISSION Act created the permanent Community Care program we know today, consolidating and streamlining existing programs into an integrated network of VA and non-VA providers.

Is VA Community Care Being Discontinued?

Over the years, the VA Community Care program has evolved and changed and even reorganized, closing its office; however, the goal is to provide a better version of healthcare to Vets, not close down the program. As of this writing, there is no plan to discontinue the program that helps Vets access healthcare they might otherwise go without.

Can I Use Both Community Care and VA Care?

If you are using VA Community Care, you will likely still be able to go to VA facilities. However, you’ll need approval from the VA before going to a community provider or you may be billed. Related reads:

Sources: VA. Accessed June 2024. https://www.va.gov/COMMUNITYCARE/ VA. Accessed June 2024. https://www.va.gov/COMMUNITYCARE/docs/pubfiles/factsheets/VHA-FS_MISSION-Act.pdf


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