How Veterans Can Access Community Care Through the VA

11 Mar How Veterans Can Access Community Care Through the VA

For many Veterans, getting timely healthcare through the Department of Veterans Affairs (VA) is essential. However, not all VA facilities offer the specialized or immediate care needed. That’s where Community Care comes in—a program that allows Veterans to receive care from non-VA providers when specific criteria are met.

If you or a loved one is a Veteran in need of medical or behavioral health services, understanding how to navigate the VA Community Care program is crucial. Here’s a step-by-step guide to accessing this benefit.

Step 1: Check Your Eligibility

The VA determines eligibility for community care based on several factors, including:

• The availability of services at a VA facility (if a required service isn’t available, community care may be an option).
• The distance and drive time to a VA facility (generally, if you live more than 30 minutes from primary care or 60 minutes from specialty care).
• The wait time for VA care (if the VA cannot provide care within a reasonable time, you may qualify).
• Whether your provider determines community care is in your best interest based on your medical needs.
• Participation in the VA’s “Grandfather” provision under the 40-mile rule for Veterans enrolled before June 2019.

Step 2: Get a Referral from the VA

Veterans cannot simply schedule an appointment with a non-VA provider and expect coverage. Instead, they must receive a referral from the VA. Here’s how that works:

1. Talk to Your VA Provider – If you believe you need care outside of the VA, discuss it with your VA doctor or care team.
2. VA Reviews Your Request – The VA will evaluate whether you meet eligibility criteria for community care.
3. Referral Approval – If approved, the VA will authorize your care and provide instructions on scheduling an appointment.

Step 3: Schedule Your Appointment

Once approved, you’ll work with a VA-authorized provider in the Community Care Network (CCN). These providers are contracted with the VA to ensure coverage for your treatment.

• The VA or the provider will contact you to schedule your appointment.
• Ensure the provider accepts VA-authorized payment to avoid out-of-pocket costs.

Step 4: Attend Your Appointment & Follow Up

• Bring your VA authorization information to your appointment.
• After your visit, the provider will send records back to the VA for continuity of care.

Step 5: Understand Your Costs

If care is not properly authorized by the VA, you could be responsible for the bill. To avoid unexpected costs:
✔ Always confirm the VA has approved the service before your visit.
✔ Use VA-authorized providers within the Community Care Network.
✔ Keep copies of your referral and appointment details.

Why Community Care Matters for Veterans

This program provides critical access to care for Veterans who may face barriers at VA hospitals, ensuring they receive timely and appropriate treatment. It also expands access to specialized care such as mental health services, substance use treatment, and other essential medical needs.

If you or a Veteran you know needs help accessing VA Community Care, don’t hesitate to reach out. Contact your VA provider or visit the VA Community Care website for more details.

Need immediate help navigating your options? First Dawn Recovery specializes in assisting Veterans with referrals, admissions, and care coordination. Reach out today to get started!