VA Community Care: Getting Treatment Outside the VA System
Community care is the VA paying a private provider to treat you. Who qualifies under the MISSION Act access standards, who actually runs the network in your region, how the 72-hour emergency clock works, and what to do when a bill turns up anyway.
Not every veteran lives near a VA medical center, and not every VA facility can provide every type of care in a timely manner. The VA Community Care program allows eligible veterans to receive healthcare from approved private providers when the VA can't meet certain access standards. Understanding when and how you can use Community Care can prevent delays in getting the treatment you need.
When you qualify
You may be eligible for Community Care if the VA cannot provide the care you need, if the VA cannot meet access standards for timeliness (generally 20 days for primary care and 28 days for specialty care), if you live more than a certain drive time from the nearest VA facility that offers the service you need (30 minutes for primary care, 60 minutes for specialty care), or if it's in your best medical interest as determined by your VA provider.
How the referral works
The process starts with your VA provider. They'll submit a referral for Community Care, and the VA will authorize treatment with an approved private provider. You don't get to simply go to any doctor and send the VA the bill — the referral and authorization must happen first, except in genuine emergencies. The VA coordinates with a third-party network administrator to find available providers in your area.
Who actually runs the network
VA does not build that network itself. It contracts the job to two third-party administrators, and knowing which one holds your area saves an afternoon on hold.
| Region | Administrator | Area |
|---|---|---|
| 1 | Optum | Connecticut, Delaware, DC, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, North Carolina, Pennsylvania, Rhode Island, Vermont, Virginia, West Virginia |
| 2 | Optum | Illinois, Indiana, Iowa, Kansas, Kentucky, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, Wisconsin |
| 3 | Optum | Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, Oklahoma, South Carolina, Tennessee, Puerto Rico, U.S. Virgin Islands |
| 4 | TriWest | Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Texas, Utah, Washington, Wyoming, American Samoa, Guam, Northern Mariana Islands |
| 5 | TriWest | Alaska |
What those two companies do is find and credential providers and process the claims providers submit. What they do not do is decide whether you are eligible for community care in the first place. That decision belongs to VA and your VA care team, which is why an administrator telling you something about your eligibility is not the same thing as VA deciding it.
Two cautions on that table. TriWest also holds the Defense Department's TRICARE West contract, which is a separate program with a separate network and its own rules — same company, so seeing the name in both places is not a mistake. And VA has a procurement underway to replace the five regions with two, an East and a West; as of August 2026 it had not announced who will hold those contracts. If a phone number or portal you were given last year no longer recognizes you, the administrator for your area may be mid-change, and your local VA medical center's community care office can tell you who holds it today.
Emergency care follows different rules
Emergency care is a separate situation. If you have a medical emergency, go to the nearest emergency room — don't try to get to a VA facility if it's not the closest option. The VA can cover emergency care at non-VA facilities under certain conditions: you must be enrolled in VA healthcare, the care must be for a condition that a reasonable person would consider an emergency, and a VA facility must not have been reasonably available. There are time limits for notifying the VA after emergency treatment, so contact the VA as soon as possible after an emergency room visit.
The 72-hour clock after an emergency
The deadline is 72 hours from when the emergency care starts. The hospital is supposed to notify VA and usually does, but you or someone acting for you can do it instead — and should, if nobody can confirm the hospital did.
There are two ways to give that notice, and a rule that took effect August 10, 2026 put both of them in the regulation. VA published a final rule on July 10, 2026 amending 38 CFR 17.4020(c)(4) so that notice can go either to the nearest VA facility, as before, or through the centralized process: the VA emergency care reporting portal, or the reporting line at 844-724-7842. Before that amendment the regulation named only the nearest VA facility, even though VA had been running the central portal for years.
Missing the 72 hours is not the cliff it usually gets described as. VA's own guidance says so plainly: if VA is not notified inside the window, the claim is not automatically denied — the episode is judged instead against the requirements for unauthorized emergency care, which is a harder standard to meet but not a closed door. Notify as soon as anyone is able to, and write down when you did it and who you spoke to.
What the MISSION Act changed
The MISSION Act expanded Community Care access standards and streamlined the process. Under current rules, the VA will also consider whether community care would better serve the veteran based on factors like the nature of the care needed, the frequency of required visits, and the veteran's preference. Your VA care team should discuss Community Care options with you during treatment planning.
Copays do not change
When using Community Care, you may still have copays depending on your priority group, just as you would at a VA facility. The copays are the same as what you'd pay at the VA — your out-of-pocket costs don't increase just because you're seeing a private provider through the program.
When a bill shows up anyway
For care VA authorized, you should never pay the community provider directly. The provider bills VA or its administrator. Your copay, if your priority group has one, is billed to you separately by VA — so a copay demand that arrives from the provider is going to the wrong place, and a bill for the full cost of an authorized visit is a billing problem rather than a debt you have to settle.
The number for this is the VA Community Care Contact Center, 877-881-7618, Monday through Friday, 8 a.m. to 9 p.m. Eastern. It is also the line VA points veterans to once a community-care bill has turned into a collection notice or a mark on a credit report, which is the reason to call before paying anything. For a copay bill VA itself sent you, the billing line is 866-400-1238.
Three things resolve these calls faster than anything else: the referral or authorization number, the itemized bill from the provider, and the date of service. Keep them together from the first appointment.
If VA denies the claim
A denial is a different problem from a misrouted bill, and it has a formal path. VHA decisions on health care benefits — including payment for community care and for emergency treatment — carry the same three review options as a disability claim, and the same one-year window.
Within one year of the date on the decision you can request a Higher-Level Review (VA Form 20-0996), where a more senior reviewer takes another look at the same evidence, or appeal to the Board of Veterans' Appeals (VA Form 10182). A Supplemental Claim (VA Form 20-0995) is the route when the problem is missing evidence rather than a misread decision — the emergency-department record establishing why a reasonable person would have called it an emergency, for instance, or proof that the nearest VA facility was not available.
After a year the options narrow rather than close: a late Supplemental Claim is still possible, and so is asking for revision on the grounds of clear and unmistakable error. Both are harder. A VSO can file any of these for free, and on a denied emergency-care bill that is usually the fastest competent help there is.