VA Community Care Explained

Community care lets VA pay for you to be treated by a non-VA provider. The part worth memorizing is the access standards, because they are specific and they are what you point to when a VA appointment is months away.

Drive time or wait time — either one qualifies you:

Type of care Average drive time Wait time
Primary care, mental health, extended outpatient care 30 minutes 20 days
Specialty care 60 minutes 28 days

Drive time is average drive time, not distance, which usually works in the veteran's favor in rural areas and traffic-heavy cities alike.

There are six routes to community care in total:

  1. VA does not provide the service you need at any VA facility.
  2. You live in a state or territory with no full-service VA health facility.
  3. You and your VA provider agree community care is in your best medical interest.
  4. VA cannot provide the service in a way that meets its own quality standards.
  5. You qualified under the old 40-mile rule as of June 6, 2018, and live in Alaska, Montana, North Dakota, South Dakota or Wyoming.
  6. VA cannot meet the drive-time or wait-time standards above.

Who is eligible?

You must be enrolled in VA health care, or otherwise entitled to VA care, and meet at least one of the six criteria.

Community care is not self-referral. VA has to authorize it before you go, or you can be left with the bill. The exception is genuine emergency care, which has its own rules — and there the deadline that matters is notifying VA within 72 hours of arriving at a non-VA facility.

Two practical notes. First, the access standards are measured against the appointment VA offers you, so ask for it in writing — "the next available is in seven weeks" is the evidence that triggers criterion 6. Second, criterion 3 is broader than most people use it: a documented agreement with your VA provider that community care is in your best medical interest is a route in its own right, without needing a distance or wait-time failure.

How do I apply?

  • Ask VA for the next available appointment date in writing: That date is what the wait-time standard is measured against.
  • Quote the standard that applies: 30 minutes or 20 days for primary care and mental health, 60 minutes or 28 days for specialty care.
  • Get authorization before you go: Unauthorized community care can leave you with the bill.
  • Use criterion 3 where it fits: A documented agreement with your VA provider is a route on its own.
  • In an emergency, make sure VA is notified within 72 hours: The provider usually does it, but you or a family member can.
  • Check the state exception: If there is no full-service VA facility in your state or territory, that alone qualifies you.

Common questions

What are the VA community care wait-time standards?

20 days for primary care, mental health and extended outpatient care, and 28 days for specialty care. Either the wait-time or the drive-time standard qualifies you.

What are the VA community care drive-time standards?

An average drive time of 30 minutes for primary care, mental health and extended outpatient care, and 60 minutes for specialty care.

Can you go to a community provider without VA approval?

No, except in a genuine emergency. Unauthorized community care can leave you responsible for the cost, so get the authorization first.

How long do you have to notify VA about emergency care at a non-VA hospital?

72 hours from arriving. The provider usually notifies VA, but you or a representative can do it.

Do you have to prove VA cannot treat you to get community care?

Not necessarily. Six criteria qualify you, including simply agreeing with your VA provider that community care is in your best medical interest.

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