VA Community Care Program in Missouri: Getting Care Outside VA
Last reviewed: September 2026
Quick Answer
VA Community Care is a federal program allowing eligible Missouri veterans to receive care from private doctors and clinics when the VA cannot timely provide services. There is no copay for authorized Community Care. The VA covers all approved treatment costs. Missouri veterans access this through the St. Louis VA Medical Center or Kansas City VA Medical Center, which coordinate non-VA care referrals.
Key Facts
- •VA Community Care lets Missouri veterans see non-VA doctors when VA capacity is exceeded.
- •Eligibility requires VA enrollment and a VA provider referral or authorization.
- •Care is coordinated through VA medical centers; Missouri has facilities in St. Louis and Kansas City.
- •There is no copay for Community Care if properly authorized by the VA.
- •Apply through VA.gov, by phone, or at your nearest VA facility in Missouri.
Federal Eligibility Requirements
VA Community Care eligibility is established under 38 U.S.C. § 1703 and § 1706, and applies uniformly nationwide including Missouri. To qualify, a veteran must first be enrolled in VA health care. Enrollment requires a discharge from active-duty service in the Armed Forces (Army, Navy, Air Force, Marine Corps, or Coast Guard) under other than dishonorable conditions.
Veterans are eligible for Community Care if they meet one or more of the following criteria: (1) the VA cannot provide the care the veteran needs within the VA system; (2) the VA cannot schedule the veteran within 28 days for primary care or urgent care appointments; (3) the VA cannot schedule specialty care within established wait time standards; (4) the veteran's residence is more than 40 miles from the nearest VA facility offering the needed service; (5) the veteran's residence is in a health professional shortage area as defined by HRSA; (6) the VA facility cannot provide the care due to lack of specialized equipment or expertise; or (7) the veteran is enrolled in a VA Program of Comprehensive Assistance for Family Caregivers.
All service eras qualify: peacetime, Persian Gulf War, Iraq War, Afghanistan War, Vietnam War, Korean War, World War II, and any period of active service. There is no minimum service length requirement beyond an honorable or general discharge. No presumptive conditions are specifically tied to Community Care eligibility—eligibility is determined by access, distance, wait time, or capability gaps, not by condition.
There are no income or asset limits for Community Care eligibility. Surviving spouses and dependents do not directly access Community Care under their own names; however, caregivers in the VA Caregiver Program may coordinate care through Community Care on behalf of the eligible veteran.
Benefit Amounts
There is no set dollar amount paid to the veteran for Community Care. Instead, the VA pays authorized Community Care providers directly for services rendered. In 2024, payment rates vary by service type and region but follow Medicare rates or negotiated rates with providers. The veteran incurs no out-of-pocket cost (zero copay) for any authorized Community Care service, including office visits, imaging, lab work, surgery, or specialist consultations. If a provider bills the veteran directly without prior VA authorization, the veteran may pursue recovery through the VA or appeal the claim. COLA adjustments do not apply to Community Care—rates are adjusted annually based on Medicare or contract renegotiation.
Missouri Benefits on Top of Federal
Missouri does not offer a separate state-level addition or enhancement to the federal VA Community Care Program. Community Care is entirely a federal program administered by the U.S. Department of Veterans Affairs with no state funding, copay assistance, or supplemental benefits layered on top.
However, Missouri does have significant VA infrastructure that affects Community Care access and coordination. The St. Louis VA Medical Center serves eastern and central Missouri (covering the greater St. Louis area, the Bootheel, and surrounding counties), while the Kansas City VA Medical Center serves western Missouri (Kansas City area and surrounding counties). Both facilities are equipped to authorize, coordinate, and oversee Community Care referrals for enrolled veterans.
Missouri also has County Veterans Service Offices in all 114 counties plus Kansas City that can help veterans understand their Community Care eligibility, prepare for VA appointments, and assist with navigation of the authorization process. These are state-funded but separate from Community Care itself.
Because Community Care is a federal-only program, Missouri veterans receive the same benefits and protections as veterans nationwide. The state does not impose additional requirements, copays, or restrictions. Any questions about state-specific veteran benefits should be directed to the Missouri Veterans Commission or your county Veterans Service Officer, but Community Care benefits remain entirely federal in scope and payment.
How to Apply
Federal VA Application
To apply for VA Community Care in Missouri, veterans first ensure they are enrolled in VA health care. Enrollment can be completed at VA.gov/health-care/enroll, by phone at 1-877-222-VETS (8387), or in person at the St. Louis VA Medical Center (1 Jefferson Avenue, St. Louis, MO 63104) or Kansas City VA Medical Center (4801 Linwood Boulevard, Kansas City, MO 64128).
Once enrolled, Community Care is not a separate application. Instead, a veteran's VA provider (primary care doctor, specialist, or VA hospital) determines medical need and initiates a referral or authorization. This can happen during a VA appointment, telehealth visit, or phone call with a VA provider. The VA provider submits the Community Care authorization electronically through the VA system.
No specific VA form is required from the veteran to use Community Care. The authorization is generated by the VA facility itself based on medical necessity and eligibility criteria (wait times, distance, capability).
Once authorized, the VA mails the veteran a letter confirming the authorization and providing details about the non-VA provider, appointment instructions, and coverage. The veteran calls the community provider to schedule. There is no copay and no billing to the veteran if the provider is in-network and the authorization is valid.
Processing of a Community Care authorization typically takes 1–5 business days, depending on urgency. Veterans can check their authorization status and scheduled appointments on VA.gov (My HealtheVet portal) or by calling their VA medical center's Community Care office directly.
St. Louis VA Community Care line: 314-652-4100 Kansas City VA Community Care line: 816-861-4700
State Application
Missouri does not administer a separate state application for VA Community Care; the program is entirely federal. However, Missouri veterans can receive free assistance navigating the federal Community Care system through the Missouri Veterans Commission and county Veterans Service Offices.
To get state-level guidance, visit the Missouri Veterans Commission website at mvc.dps.mo.gov or call 1-800-342-7648. The commission can explain Community Care eligibility, help you confirm enrollment status, and direct you to the nearest VA facility and County Veterans Service Office.
Each of Missouri's 114 counties has a County Veterans Service Office (CVSO). These offices are staffed by trained veterans benefits counselors who provide free, in-person assistance. Services include helping you prepare documentation for VA visits, explaining your eligibility for Community Care based on distance or wait times, and helping you understand authorization letters from the VA.
To find your County CVSO, visit mvc.dps.mo.gov/county-veterans-service-offices or call the Missouri Veterans Commission. Offices are open during business hours and typically require no appointment for initial consultations.
If you are homebound or unable to visit in person, many CVSOs offer phone consultations. Some Missouri veterans' hospitals also have patient advocates who can assist with Community Care questions and complaints.
Processing through the state-level assistance is free and immediate; the actual VA authorization (which is the federal application) typically takes 1–5 business days once a VA provider submits the referral.
Common Reasons for Denial
Community Care authorizations are rarely formally denied in writing; instead, they are not authorized or are cancelled due to specific issues. The most common reasons a veteran may not receive Community Care are:
1. Not Enrolled in VA Health Care: The single most common barrier. If a veteran is not enrolled in the VA health system, they cannot receive Community Care. Many veterans believe they are automatically enrolled after discharge; they are not. Remedy: Complete enrollment immediately at VA.gov/health-care/enroll or visit your nearest VA facility in Missouri.
2. No VA Provider Referral or Authorization: Community Care cannot be accessed directly by a veteran. A VA doctor must determine medical necessity and submit the authorization. If a veteran tries to schedule a private doctor without a VA referral, the VA will not cover it. Remedy: Schedule an appointment with your VA primary care doctor or specialist to request a Community Care referral.
3. Ineligibility Criteria Not Met: If the VA determines it can provide the care timely (within 28 days for primary care), the veteran is within 40 miles of a VA facility offering the service, or the VA has the capability to provide the service, a Community Care authorization may not be issued. Remedy: Request a formal review of your eligibility or ask your VA provider to document why the VA cannot meet your care needs.
4. Authorization Expires or Was Cancelled: Community Care authorizations are time-limited (typically 60–120 days depending on service type). If you miss your appointment, the authorization expires. If the VA facility cancels it due to administrative error or your discharge from the program, you will need a new authorization. Remedy: Check your authorization status immediately on VA.gov. If expired, contact your VA provider to request a new referral.
5. Non-VA Provider Not in Network or Not Contracted: Some private doctors, labs, or facilities are not contracted with the VA or are out-of-network. The VA may deny coverage if you choose an unauthorized provider. Remedy: Use only providers listed in your Community Care authorization letter. Ask the VA to identify in-network providers before scheduling.
6. Services Are Non-Covered or Not Medically Necessary: Cosmetic procedures, experimental treatments, or services deemed not medically necessary by the VA may not be authorized. Remedy: Contact your VA provider to clarify what is covered before scheduling and obtain written authorization.
To build a stronger initial claim for Community Care, request a Community Care authorization in writing during or after a VA visit, document your distance from the VA facility and any wait times you are experiencing, ask your VA provider to note any gaps in VA capability or specialty expertise, and keep copies of all authorization letters and provider communications.
If You Are Denied: The Appeals Process
If you believe your Community Care authorization was improperly denied, cancelled without cause, or you disagree with a coverage decision, you have the right to appeal under the three-lane appeal system established by the VA, codified in 38 U.S.C. § 5104B and implemented via 38 C.F.R. § 20.200 et seq.
Lane 1: Supplemental Claim (Fastest Lane for New Evidence). If you have new evidence (e.g., a provider letter, new medical records, or documentation of a 40+ mile distance you did not provide before), you can file a Supplemental Claim within one year of the original decision. File on VA Form 20-0995 at VA.gov/claim-or-appeal or by mail to the VA Regional Office in St. Louis (mail address on form). Processing time: 4–6 months. This lane works best if your original claim lacked key supporting documents.
Lane 2: Higher-Level Review (HLR) (Best if Decision Was Clearly Wrong). If the original decision was factually or legally incorrect but you have no new evidence to add, request a Higher-Level Review on VA Form 20-0996 within one year. A more senior VA rater will review the same evidence. Processing time: 4–6 months. This lane is effective if the VA misinterpreted your eligibility (e.g., miscalculated your distance from the VA facility or misapplied wait time rules).
Lane 3: Board of Veterans' Appeals (BVA) (Final Federal Review). If you disagree with the Supplemental Claim or HLR decision, or if more than one year has passed since the original decision, you can appeal to the BVA on VA Form 10182 (Notice of Disagreement). The BVA is an independent board of veterans law judges. You may request an oral hearing (video or in-person). Processing time: 6–12 months or longer. This lane is appropriate for complex cases or if you want a hearing.
Deadlines: You must file within one year of the original decision. If you miss the one-year deadline, you can still request an appeal, but you must show good cause for the delay.
Free Help: All appeals are free. The VA provides free assistance through Accredited Representatives with the VA, and Missouri's County Veterans Service Offices provide free appeal consultation and help preparing your appeal documents. The American Legion, Veterans of Foreign Wars (VFW), and Disabled American Veterans (DAV) are also accredited to represent veterans in appeals at no cost. Never pay a VA claims agent or attorney to file an appeal; it is illegal.
For Missouri, contact your County CVSO at mvc.dps.mo.gov for free appeal assistance, or contact the VA regional office in St. Louis at 1-800-827-1000.
Need help understanding your Community Care eligibility or preparing a referral? Contact your county Veterans Service Office in Missouri for free assistance. Call the Missouri Veterans Commission at 1-800-342-7648 or visit mvc.dps.mo.gov to find your local office. You can also reach out to the American Legion, Veterans of Foreign Wars (VFW), or Disabled American Veterans (DAV)—all provide free veteran services and benefits counseling.
Get notified when VA benefit rates change
Benefit rates and eligibility rules update — usually each January. We'll let you know when they do.
Frequently Asked Questions
What is VA Community Care and who can use it in Missouri?
VA Community Care is a federal program that lets enrolled Missouri veterans receive medical care from private doctors, clinics, and hospitals outside the VA system when the VA cannot provide timely or specialized care. To use it, you must be enrolled in VA health care and have a VA provider (doctor or facility) authorize the Community Care referral. You do not apply separately for Community Care; instead, your VA provider determines whether you qualify based on wait times, distance from the nearest VA facility, or lack of specialized services. If you meet eligibility criteria—such as the VA cannot schedule you within 28 days for primary care, you live more than 40 miles from a VA facility, or the VA lacks the expertise or equipment—a referral is issued. There is no copay for authorized Community Care. Missouri veterans access Community Care through the St. Louis VA Medical Center (serving east and central Missouri) or the Kansas City VA Medical Center (serving west Missouri).
How do I enroll in VA health care to access Community Care in Missouri?
To access Community Care, you must first be enrolled in VA health care. Enrollment is free and quick. You can enroll online at VA.gov/health-care/enroll by filling out VA Form 10-10EZ. You do not need to download or print the form; you can complete it entirely online using your VA.gov login (if you already have one) or by creating a new account. You can also apply by phone by calling 1-877-222-VETS (8387), Monday through Friday 8 a.m. to 8 p.m. ET. If you prefer in person, visit the St. Louis VA Medical Center at 1 Jefferson Avenue, St. Louis, MO 63104, or the Kansas City VA Medical Center at 4801 Linwood Boulevard, Kansas City, MO 64128. Both facilities have enrollment staff who can register you on the spot. Enrollment typically takes 1–2 weeks once submitted. You will receive a welcome letter and information about your assigned primary care clinic. Once enrolled, you are eligible for all VA benefits, including Community Care.
How do I request a Community Care authorization and what happens next?
You do not directly request Community Care—your VA provider initiates the referral based on medical need. To start the process, schedule an appointment with your VA primary care doctor or relevant specialist. During the visit, tell your provider about any barriers you face (long wait times, distance from the VA, specialized care needs). Your VA provider will assess whether Community Care is appropriate and submit an authorization electronically through the VA system. This typically takes 1–5 business days. Once approved, the VA mails you a letter with the authorization details, including the name and address of the non-VA provider, your authorization number, and any coverage limits. You then call the private provider to schedule your appointment. On the day of your appointment, bring your VA Community Care authorization letter and photo ID. The community provider bills the VA directly; you pay nothing out of pocket. After your visit, the provider sends clinical notes back to your VA facility so your VA medical team stays informed of your care.
What happens if I do not have a VA primary care doctor or if I am new to the VA in Missouri?
If you are newly enrolled in VA health care in Missouri, you will be assigned a primary care clinic based on your location and the VA facility serving your area. You will receive a letter with the name of your clinic and instructions to schedule your first appointment. Call that clinic directly to book. Your first appointment is typically an initial health evaluation where you and your VA doctor discuss your medical history, current health needs, and any barriers to care. During this first visit, if you already know you need a specialist, out-of-area provider, or face other access challenges, tell your VA doctor. They can recommend Community Care or pursue other options. If you have not yet been assigned a primary care clinic, contact the St. Louis VA (314-652-4100) or Kansas City VA (816-861-4700) and ask to be assigned to the clinic nearest your home. Do not delay—getting an active primary care relationship is essential for accessing any VA service, including Community Care.
What if I disagree with a Community Care denial or authorization cancellation?
If your Community Care authorization was denied or cancelled and you believe it was wrong, you have the right to appeal. You can file one of three types of appeals: (1) Supplemental Claim (VA Form 20-0995) if you have new evidence such as a provider letter, medical records, or proof of distance from the VA; (2) Higher-Level Review (VA Form 20-0996) if the VA made a factual or legal error in interpreting eligibility; or (3) Board of Veterans' Appeals (BVA) (VA Form 10182) for a final independent review by a veterans law judge. All appeals are free and must be filed within one year of the original decision. To file, visit VA.gov/claim-or-appeal or contact your County Veterans Service Office in Missouri for free help preparing your appeal. The Missouri Veterans Commission (mvc.dps.mo.gov, 1-800-342-7648) can also guide you. Do not hire a paid claims agent—you are entitled to free representation from accredited veterans service organizations like the American Legion, VFW, or Disabled American Veterans.
Related Benefits in Missouri
Sources & References
- 38 U.S.C. § 1703 — Establishes VA authority to contract for care outside system
- 38 U.S.C. § 1706 — Creates specific Community Care eligibility and authorization standards
- 38 C.F.R. § 17.4000 et seq. — Defines Community Care eligibility, authorization, coordination procedures
- VA Directive 1003.01 — Implements VA Community Care Program policies nationwide
VA benefit rules and state programmes change. Verify at va.gov or with a free Veterans Service Officer.
Editorial standards: This guide is reviewed against primary government sources and cites 4 statutes. Last reviewed September 2026. Scheduled for re-verification by September 2027.
See our editorial policy for how content is created and verified, or report an inaccuracy.