In this situation, a Veteran needs a specific type of care or service that VA does not provide in-house at any of its medical facilities.

For example, if you are a female Veteran and need maternity care, you would be eligible for community care because VA does not provide maternity care in any of its medical facilities.

In this scenario, a Veteran lives in a U.S. state or territory that does not have a full-service VA medical facility. Specifically, this applies to Veterans living in:.

U.S. States

• Alaska
• Hawaii
• New Hampshire

U.S. Territories

• Guam
• American Samoa
• Northern Mariana Islands
• U.S. Virgin Islands

For instance, if you are a Veteran living in Guam, you would be eligible for community care because you reside in a state or territory without a full-service VA medical facility.

For this element, there are a few different ways that a Veteran could be eligible for community care. Initially, there are two requirements that must be met in every case:

1. Veteran was eligible under the 40-mile criterion under the Veterans Choice Program on the day before the VA MISSION Act was enacted into law (June 6, 2018), and
2. Veteran continues to reside in a location that would qualify them under that criterion.

If both of these requirements have been met, a Veteran may be eligible if one of the following is also true:

• Veteran lives in one of the five states with the lowest population density from the 2010 Census:
  North Dakota, South Dakota, Montana, Alaska, and Wyoming, or
• Veteran:
  • lives in another state,
  • received care between June 6, 2017, and June 6, 2018, and
  • requires care before June 6, 2020.

For example, if you are a Veteran who has lived in Kansas since 2012, your home is 41 miles driving distance to the nearest VA medical facility with a full-time primary care physician, and you received VA care between June 6, 2017, and June 6, 2018, you would be eligible for community care until June 6, 2020.

In this situation, VA is unable to schedule an appointment that is within both average driving time standards and wait time standards. For average drive time to a specific VA medical facility, the access standards are:

• 30-minute average drive time for primary care, mental health, and non-institutional extended care services (including adult day health care)
• 60-minute average drive time for specialty care

For appointment wait times at a specific VA medical facility, the access standards are:

• 20 days for primary care, mental health care, and non-institutional extended care services, unless the Veteran agrees to a later date in consultation with their VA health care provider
• 28 days for specialty care from the date of request, unless the Veteran agrees to a later date in consultation with their VA health care provider

For instance, if you are a Veteran and live 10 miles from the nearest VA primary care provider, but it takes you over an hour to drive there on average due to heavy traffic, you would be eligible for community care.

In this situation, a Veteran may be referred to a community provider when the Veteran and the referring clinician agree that it is in the best medical interest to see a community provider.

For example, if you are a Veteran with a certain type of ovarian cancer that your VA oncologist is not experienced in treating, and you live close to a community medical facility where there is a specialist for that type of cancer, you could be eligible for community care if the clinician and patient agree that this treatment should be provided by the community medical facility.

In this scenario, if VA has identified a medical service line is not meeting VA’s standards for quality based on specific conditions, Veterans can elect to receive care from a community provider under certain limitations.

For example, if VA has identified that the cardiology service line at a local VA medical facility is not providing care that meets VA’s standards for quality, the Veteran may be able to elect to receive your cardiology care in the community. However, there may be limits on when, where, and what is available under this criterion.

For additional information and frequently asked questions (FAQs), refer to the Veteran Community Care – Eligibility fact sheet.

A consult is a request from your VA doctor to refer you for medical and/or behavioral care from a VA community provider. When your VA provider recommends you seek additional care, they create the consult and VA staff review it for accuracy.

Do not schedule an appointment until VA contacts you with the approved consult information.

Want to know more about community care? Visit: www.va.gov/communitycare

Once VA has contacted you with the approved consult information, you may proceed to schedule your appointment. If you prefer, VA can schedule the appointment for you. Otherwise, you may self-schedule by calling a VA community provider directly, or use VA Online Scheduling, mobile.va.gov/app/va-online-scheduling.

If you decide to self-schedule, VA will call you up to three times to verify that your appointment is scheduled. If you do not schedule your appointment within 14 business days, you will have to request a new consult from the referring VA provider.

To find a VA community provider: visit www.va.gov/find-locations.

After your appointment is scheduled, your authorization is created. An authorization is approval from VA for you to receive care from a community provider.

You will receive a letter in the mail with:

• Your authorization number.
• The in-network community provider you are approved to visit.
• A description of the care you are approved to receive.
• The time period you are authorized to receive care.

Bring the authorization letter with you to your appointment with the community provider.

At the scheduled day and time, you will attend your community care appointment. The VA will send any relevant medical records to your community provider. However, if instructed by the community provider, you may need to bring copies of diagnostic imaging (CT or MRI) with you.