KEY TAKEAWAYS
- The MISSION Act lets veterans enrolled in (or eligible for) VA health care use private providers at VA expense when they meet any one of six eligibility criteria. GAO found community care made up about 40% of all VA health care in fiscal 2023.
- The access standards are 20 days (primary care, mental health) or 28 days (specialty care) for wait times, and 30 minutes or 60 minutes of average drive time. If VA can’t meet them, you qualify.
- The urgent care benefit needs no prior authorization. Priority groups 1-5 pay $0 for the first three visits a year and $30 after that; groups 7-8 pay $30 a visit.
- Referrals are faster: since May 2025 a second VA doctor no longer has to approve “best medical interest” referrals, and since August 2025 VA issues year-long authorizations for 30 standardized types of care.
- The Veterans’ ACCESS Act, which would write these standards into law, had not passed either chamber of Congress in the records available in October 2026, so the standards remain regulatory.
- What Is the VA MISSION Act?
- The 6 Eligibility Criteria for Community Care
- Access Standards: Wait Times and Drive Times
- How to Access Community Care
- The Urgent Care Benefit
- What Services Are Covered
- Prescriptions Through Community Care
- Copayments for Community Care
- Recent Changes and the Veterans’ ACCESS Act
- Frequently Asked Questions
The VA MISSION Act gives veterans more choices in where they receive healthcare. If you’re enrolled in VA health care and face long wait times, live far from a VA facility, or need specialized care the VA doesn’t offer, you may be eligible to see private doctors and have the VA pay for it. By fiscal 2023, community care made up about 40% of all VA health care, according to GAO, yet many veterans still don’t know they have this option or how to use it. This guide explains the six eligibility criteria, the wait-time and drive-time standards, the urgent care benefit and its copays, and the 2025 and 2026 changes that make referrals faster.
What Is the VA MISSION Act?
The VA MISSION Act (Maintaining Internal Systems and Strengthening Integrated Outside Networks Act) was signed into law in June 2018 and took effect on June 6, 2019. It replaced the troubled Veterans Choice Program with a more streamlined system called the Veterans Community Care Program. You can check the criteria on VA’s community care eligibility page.
The law represents a fundamental shift in how the VA approaches healthcare delivery. Rather than treating community care as a last resort, the MISSION Act establishes clear eligibility criteria that give veterans the option to receive care from private providers when it’s in their best interest.
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Key features of the MISSION Act include:
- Expanded eligibility for receiving care outside VA facilities
- Clear access standards based on wait times and drive times
- A new urgent care benefit for walk-in treatment of minor conditions
- Expanded caregiver support through the Program of Comprehensive Assistance for Family Caregivers
- Improved coordination between VA providers and community care providers
You have to be in the system first. Community care is available to veterans who are enrolled in or eligible for VA health care. If you haven’t enrolled yet, start with our guide to VA health care enrollment.
The 6 Eligibility Criteria for Community Care
Under the MISSION Act, you may be eligible for community care if you meet any one of these six criteria. VA staff generally make the eligibility determination.
1. The Care You Need Is Not Available at a VA Facility
If the VA doesn’t provide a specific service you need at any VA health facility, you can receive that care from a community provider. For example, the VA doesn’t provide maternity delivery services at most facilities, so pregnant veterans are routinely referred to community obstetrics providers.
2. You Live in a State or Territory Without a Full-Service VA Facility
This applies to veterans living in Alaska, Hawaii, New Hampshire, and U.S. territories including Guam, American Samoa, the Northern Mariana Islands, and the U.S. Virgin Islands. If you live in one of these areas, you have expanded community care options.
3. You Qualify Under the Grandfather Provision
If you qualified under the old Veterans Choice Program’s 40-mile distance requirement as of June 6, 2018, and you live in Alaska, Montana, North Dakota, South Dakota, Wyoming, or another location that would still make you eligible under those requirements, you may still qualify under this grandfathered provision.
4. The VA Cannot Meet Access Standards
This is the most commonly used eligibility criterion. If the VA cannot offer you an appointment within the designated access standards for wait times or drive times (see below), you qualify for community care.
5. It’s in Your Best Medical Interest
You and your VA provider can agree that receiving care from a community provider is in your best medical interest. This might apply if you have a complex condition that requires specialized expertise, or if continuity of care with a community provider would lead to better outcomes.
Since May 2025 this has been faster. Previously, “best medical interest” determinations required a second VA doctor to review the referral. Under the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act, VA removed that extra review, so once you and your clinician agree on a referral, it no longer needs another VA doctor’s sign-off.
6. VA Service Does Not Meet Quality Standards
If a VA medical service line is not meeting the VA’s own quality standards, you may be referred to a community provider for that specific service. The VA monitors quality metrics and identifies when certain service lines fall below acceptable thresholds.
Access Standards: Wait Times and Drive Times
The MISSION Act established specific access standards (set in regulation at 38 CFR § 17.4040) that determine when you’re eligible for community care based on wait times or drive times. They are calculated using VA systems and geomapping software, and either one is enough.
Wait Time Standards
| Type of Care | Maximum Wait Time |
|---|---|
| Primary care | 20 days from date of request |
| Mental health care | 20 days from date of request |
| Non-institutional extended care | 20 days from date of request |
| Specialty care | 28 days from date of request |
If the VA cannot schedule your appointment within these timeframes, you become eligible for community care.
Drive Time Standards
| Type of Care | Maximum Average Drive Time |
|---|---|
| Primary care | 30 minutes |
| Mental health care | 30 minutes |
| Non-institutional extended care | 30 minutes |
| Specialty care | 60 minutes |
Drive times are calculated from your home to the nearest VA facility that provides the specific care you need, not just the nearest VA facility in general. The VA uses geomapping software for these calculations. If you believe your actual drive time is longer than what the system shows, discuss this with your VA care team.
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How to Access Community Care
Here’s the step-by-step process for accessing community care under the MISSION Act:
Step 1: Talk to Your VA Care Team
Start by discussing your healthcare needs with your VA primary care provider or the relevant specialty clinic. They can determine whether you meet any of the eligibility criteria for community care.
Step 2: Get Authorization
In most cases, you must receive prior authorization from the VA before seeing a community provider, or you risk being billed for the care. Your VA care team will submit a referral through the VA’s system if you’re eligible. The exception is urgent care (see below), which doesn’t require prior authorization.
Step 3: Choose a Provider
Once approved, you can work with VA staff to find an in-network community care provider. You can accept the provider VA recommends or search for a different in-network provider. Use the VA Facility Locator to search for community care providers near you.
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Step 4: Schedule Your Appointment
You or the VA will contact the community provider to schedule your appointment. The provider will verify your eligibility and authorization before providing care.
Step 5: Receive Care
Attend your appointment. The community provider will send documentation back to the VA for your records. Any follow-up care or referrals should be coordinated through your VA care team.
How Long Does an Authorization Last?
On August 5, 2025, VA announced year-long community care authorizations for 30 standardized types of care, so eligible referrals get 12 full months of uninterrupted treatment at VA expense before you need a reauthorization. Before the change, some specialty referrals were re-evaluated every 90 to 180 days. VA’s list covers heart, skin, hormone and metabolic, nervous system, ear, nose and throat, digestive, kidney, eye, bone and joint, lung, sleep, cancer and blood, and mental health and addiction care; see the VA announcement for the full list. Eligibility requirements didn’t change.
Important Phone Numbers
- VA Health Resource Center: 1-877-222-VETS (1-877-222-8387)
- Community Care general questions: 1-844-698-2311
- Urgent care eligibility: 800-698-2411 (TTY: 711), then select options 1, 3 and 1
The Urgent Care Benefit
One of the most valuable features of the MISSION Act is the urgent care benefit. This allows eligible veterans to visit walk-in urgent care clinics for minor illnesses and injuries without prior VA authorization.
What the Urgent Care Benefit Covers
Urgent care is for non-emergency conditions that need prompt attention but aren’t life-threatening. It covers services from urgent care centers and walk-in retail clinics, including diagnostic services such as X-rays and some lab tests. Examples include:
- Sore throats and ear infections
- Colds, coughs, and flu-like symptoms
- Minor skin infections and rashes
- Pink eye
- Minor burns and cuts
- Sprains and strains
- Urinary tract infections
Eligibility for Urgent Care
To use the urgent care benefit, you must:
- Be enrolled in VA healthcare
- Have received VA care (from a VA or community provider) within the past 24 months
How to Use Urgent Care
- Find an in-network urgent care provider using the VA Facility Locator (select “Urgent care”)
- Verify the provider is part of VA’s contracted network before receiving care
- Tell the provider you want to use your VA urgent care benefit
- The provider will verify your eligibility
- Receive treatment—no authorization needed
There are two types of urgent care locations: retail clinics (like CVS MinuteClinic or Walgreens) for simple issues like sore throats, and urgent care centers for more involved treatment like splinting or wound care.
What Urgent Care Does NOT Cover
- Preventive care (annual physicals, routine screenings)
- Dental care
- Emergency care (chest pain, severe bleeding, difficulty breathing—go to the ER)
- Follow-up care for chronic conditions
What Services Are Covered
The Veterans Community Care Program covers a wide range of healthcare services, including:
- Primary care
- Specialty care (cardiology, orthopedics, dermatology, etc.)
- Mental health services
- Substance abuse treatment
- Emergency care (with notification to VA within 72 hours)
- Urgent care
- Extended care services
- Maternity care
- Some surgical procedures
Dental care eligibility has not changed under the MISSION Act. Dental services through community care are only available to veterans who already qualify for VA dental benefits, and most veterans are not eligible for comprehensive VA dental care unless they have a service-connected dental condition or meet other specific criteria; see our guide to VA dental eligibility classes. What is changing is the network behind it: on September 30, 2026, VA awarded Optum Serve a 10-year contract worth up to $30 billion to build and run a national dental network, rolling out in phases. VA says about 26% of enrolled veterans are eligible for VA dental care.
Prescriptions Through Community Care
When you receive care from a community provider, prescription medications work differently than at the VA:
For Urgent Care Prescriptions
- Up to a 14-day supply: VA covers urgent care prescriptions filled at an in-network community pharmacy in the same state as your visit. Opioid prescriptions are limited to 7 days, or your state’s limit if lower
- Out-of-network pharmacy: You may have to pay the full cost and then file a reimbursement claim with VA
- More than 14 days: Must be filled through a VA pharmacy
For Other Community Care Prescriptions
Long-term or routine prescriptions from community care visits should generally be submitted to the VA pharmacy to be filled. This ensures continuity with your VA medical record and may result in lower costs.
Medication copays for a 30-day supply filled through VA depend on your priority group. Priority group 1 pays nothing. Groups 2 to 8 pay $0, $5, $8 or $11 depending on the drug tier, and medication copays are capped at $700 per calendar year.
Copayments for Community Care
Copayments for community care work the same as copayments for VA care. Whether you owe a copay depends on your VA priority group and whether the condition is related to your military service.
Urgent Care Copayments
| Priority Group | First 3 Visits/Year | 4th+ Visits/Year |
|---|---|---|
| Groups 1-5 | $0 | $30 |
| Group 6 (visit related to a special authority or exposure) | $0 | $30 |
| Group 6 (other) | $30 | $30 |
| Groups 7-8 | $30 | $30 |
If you only get a flu shot at your visit, you owe no copay in any priority group. Copayments are billed by the VA after your visit, so you don’t pay the provider directly. Not sure of your priority group? It depends on factors like service-connected disability rating, income, and service history, and your VA enrollment office can tell you.
Outpatient Care Copayments
For non-urgent community care visits, copayments may apply if the care is for a non-service-connected condition:
- Primary care: $15 per visit
- Specialty care: $50 per visit
- Specialty tests such as an MRI or CT scan: $50
- X-rays, lab tests, and preventive services: no copay
Many veterans are exempt from copayments based on their disability rating (see our VA disability ratings guide), income level, or other factors. The amounts above come from VA’s copay rates page. Check with your VA enrollment coordinator to understand your copay obligations.
Recent Changes and the Veterans’ ACCESS Act
The VA has continued to expand and change community care since the MISSION Act’s launch. Here is what changed over the past 17 months.
May 2025: No Second Review for Best Medical Interest Referrals
On May 19, 2025, VA announced it would implement a provision of the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act that removes the second VA physician review of “best medical interest” referrals, effective immediately. Previously, even after a veteran and their clinician agreed that community care was appropriate, a second VA doctor had to validate the referral before it became final. VA also said it would train employees to follow the new process.
August 2025: Year-Long Authorizations
On August 5, 2025, VA extended new community care authorizations to one year for 30 standardized types of care, replacing the 90-to-180-day reviews that applied to some specialty referrals. See “How Long Does an Authorization Last?” above for the list.
December 2025: Community Care Network “Next Generation”
On December 15, 2025, VA issued a request for proposals to restructure the Community Care Network, the contracts that build the provider networks and process claims. The plan cuts the number of regions from five to two (Next Generation East and West) under contracts worth up to $1 trillion over 10 years, and proposals were due March 16, 2026. The current contracts, awarded in 2018, expire in 2026. This is a back-office change to who administers the network, and the eligibility rules above stayed the same. VA also awarded its national dental network under the new contracting structure on September 30, 2026 (see the dental section above). Check VA.gov for the current status of the medical network awards.
The Veterans’ ACCESS Act of 2025
Congress is still considering the Veterans’ ACCESS Act of 2025 (H.R. 740 / S. 275). The House Veterans’ Affairs Committee advanced it on July 23, 2025, and the Senate Veterans’ Affairs Committee ordered it reported in late July 2025. In the records available in October 2026, neither chamber has passed it, and Senate committee leaders have since folded it into a 62-bill package, the Take Care of America’s Veterans Act, announced in June 2026. Check Congress.gov for the current status. The bill would:
- Codify access standards into law: The current wait time and drive time standards are regulatory. This bill would make them statutory, preventing a future administration from changing them without Congress, with a review of the standards at least every three years
- Require notification: VA would have to notify veterans of their community care eligibility, and of any denial of a request
- Create a pilot program: Veterans could access outpatient mental health and substance use treatment from community providers without prior VA approval, as a three-year pilot
- Expand online tools: VA would build an online self-service system for scheduling and tracking appointments
Supporters, led by the chairmen of the House and Senate Veterans’ Affairs Committees, say it would protect the MISSION Act’s standards from being rolled back. Opponents, including Democrats on the House committee, argue community care should not come at the expense of direct VA care.
KEEP READING
VA Health Care Enrollment: How to Apply →
Community care starts with enrollment. Here’s who qualifies and how to sign up.
Community care is for veterans. CHAMPVA covers eligible spouses and children.
VA Veterans Benefits: Complete Guide →
Every VA benefit for veterans and their families, in one place.
Frequently Asked Questions
No. Eligibility for community care gives you the option to see a private provider, but you can always choose to receive care at a VA facility instead. The choice is yours.
Yes. You must be enrolled in, or eligible for, VA health care, and you must meet at least one of the six eligibility criteria. If you haven’t enrolled yet, see our guide to VA health care enrollment.
No. The Veterans Community Care Program and urgent care benefit are only for enrolled veterans. Eligible spouses and children may qualify for health coverage through CHAMPVA instead. Our guide to VA benefits for spouses of veterans covers the other options.
For true emergencies (chest pain, severe bleeding, difficulty breathing, etc.), go to the nearest emergency room. You should notify the VA within 72 hours of receiving emergency care. Emergency care is handled differently from routine community care and has its own reimbursement process.
Use the VA Facility Locator and select “Urgent care” to find in-network providers. Before your visit, confirm with the provider that it is in VA’s network by looking for posted signage or asking staff.
If you believe you meet the eligibility criteria but your referral was denied, discuss the decision with your VA care team, contact the VA Patient Advocate at your facility, and ask about filing a clinical appeal. The pending Veterans’ ACCESS Act would require VA to notify veterans of denials and report to Congress on the appeals process.
Community providers receive relevant medical documentation when you’re referred for care. After your appointment, they’re required to send treatment notes back to the VA for inclusion in your record. This coordination helps ensure continuity of care.
The MISSION Act expanded telehealth options, allowing VA providers to deliver care across state lines. Some community care services may also be available via telehealth depending on the provider and type of care needed.
Approval times vary depending on the type of care and your facility’s processes. Since May 2025, “best medical interest” referrals no longer need a second VA doctor’s review, so many referrals move faster. For urgent care, no approval is needed: you can walk in to an in-network provider immediately.
It depends on the type of care. For 30 standardized types of care, including heart, skin, bone and joint, sleep, cancer and mental health care, VA now issues year-long authorizations, meaning 12 months of treatment before you need a reauthorization. Before August 2025, some specialty referrals were re-evaluated every 90 to 180 days.
Only if you already qualify for VA dental benefits. The MISSION Act didn’t change dental eligibility, and most veterans aren’t eligible for comprehensive VA dental care. See our guide to VA dental eligibility. VA awarded a national dental network contract on September 30, 2026, which is rolling out in phases.
This article is provided by USMilitary.org, an independent educational resource. We are not affiliated with the Department of Defense, VA, or any government agency. For official information about VA community care, visit VA.gov or call 1-844-698-2311.
