VA Community Care Program in Virginia: Getting Care Outside VA
Last reviewed: September 2026
Quick Answer
VA Community Care is a federal program that allows eligible Virginia veterans to receive healthcare from private doctors and hospitals when VA medical facilities cannot provide timely care. Under Community Care, veterans can access primary care, specialty services, urgent care, mental health services, and other authorized treatments at no copay. Virginia veterans who are enrolled in VA health insurance and meet eligibility criteria can request Community Care services through their local VA medical center or online through VA.gov.
Key Facts
- •VA Community Care lets Virginia veterans access care from private doctors and hospitals.
- •You qualify if VA cannot meet your healthcare needs within established wait times.
- •Community Care covers primary care, specialty care, urgent care, and mental health services.
- •Apply through VA.gov or contact your VA medical center directly.
- •There are no copays for eligible veterans receiving Community Care services.
Federal Eligibility Requirements
To qualify for VA Community Care, Virginia veterans must first be enrolled in the VA health care system. Eligibility is established through 38 U.S.C. section 1703A and 38 C.F.R. section 17.3500, which define who can receive care through community providers.
You qualify for Community Care if you are a veteran with an honorable or general discharge and meet one of these conditions: you are enrolled in VA health care; you have been approved for VA health care; or you are eligible for emergency VA health care services. Service connection status, disability rating, or specific service eras do not determine Community Care eligibility—enrollment in the VA health care system is the primary requirement.
The MISSION Act of 2018 (Public Law 115-182) expanded Community Care access significantly. Under current standards, you qualify if the VA cannot schedule your appointment within 20 days of your preferred date; you live more than 40 miles from the nearest VA facility; you live more than one hour travel time from the nearest VA facility; you have a medical condition that requires specialized care not available at nearby VA facilities; or you would benefit from continuity of care with an established provider.
Spouses and dependents of deceased veterans are not eligible for Community Care unless they qualify through their own separate VA health care enrollment. There are no income limits or asset restrictions for Community Care eligibility. Veterans who are not yet enrolled in VA health care must enroll first before accessing Community Care benefits.
Benefit Amounts
VA Community Care has no copay requirement for eligible veterans receiving authorized services. This means there is no out-of-pocket cost for Community Care appointments, procedures, or treatments. The VA reimburses community providers at negotiated rates, and veterans pay nothing at the point of service for covered services. However, veterans remain responsible for copays on VA prescription medications filled at VA pharmacies. Community Care covers unlimited outpatient visits, specialist consultations, diagnostic testing, mental health counseling, and other authorized services for enrolled veterans. Annual COLA adjustments do not directly affect Community Care availability, though VA provider reimbursement rates are adjusted annually based on federal guidelines.
Virginia Benefits on Top of Federal
Virginia does not provide state-level additions to the VA Community Care program. Community Care is exclusively a federal VA program with no state funding supplement or state-specific enhancements. Virginia has not created a parallel state healthcare program for veterans through Community Care mechanisms, nor does the Commonwealth provide additional reimbursement or services that layer on top of federal Community Care benefits.
This is because VA Community Care is a federally funded and administered program under the Veterans Health Administration (VHA), established by federal statute at 38 U.S.C. section 1703A. States do not have statutory authority to modify or enhance Community Care eligibility or benefits; these are determined exclusively by federal law and VA policy. Virginia veterans receive the same Community Care access, covered services, and reimbursement rates as veterans in all other states.
However, Virginia does operate separate state veterans benefits programs that can complement federal Community Care services. Virginia offers the Virginia Veterans Care Center program, emergency financial assistance, and other state-funded benefits that veterans can use in addition to Community Care, but these are distinct programs with separate applications and eligibility criteria. Veterans in Virginia should explore both federal Community Care and state-specific benefits to maximize their available healthcare and support options.
How to Apply
Federal VA Application
To apply for VA Community Care in Virginia, you must first ensure you are enrolled in the VA health care system. Visit VA.gov/health-care to begin the enrollment process if you have not already done so. Complete VA Form 10-10EZ (Application for Health Benefits) online, by phone, or in person at your nearest VA facility.
Once enrolled, you can request Community Care services through multiple methods. The preferred online method is through your VA.gov account by logging in and accessing the Healthcare section. Click on "Request Community Care" and specify the type of care you need (primary care, specialty, urgent, mental health, etc.). You can also call the VA's Community Care line at 1-844-842-4681 to request services by phone.
You may also visit in person at the VA Medical Center in Richmond, Salem, or your local VA clinic in Virginia to request Community Care services. VA staff will determine your eligibility based on the 20-day wait time standard, 40-mile distance rule, or specialized care needs. Bring your VA insurance card or enrollment verification.
Required documents include your identification (driver's license or passport), Social Security number, and proof of military service (DD Form 214). If you have existing medical records from private providers, bring those as well to speed up the referral process.
After submission, the VA typically processes Community Care requests within 5-10 business days. You will receive notification by phone or mail confirming whether you have been approved for Community Care and the name and contact information of your assigned community provider. The VA will schedule your first appointment and send you appointment confirmation details. You can check your claim status anytime through VA.gov or by calling your local VA medical center's Community Care coordinator.
State Application
Virginia does not have a separate state application process for Community Care because this is a federal VA program. However, Virginia veterans can access support through state resources to help with the federal application process. The Virginia Department of Veterans Services (DVS) operates throughout the state and can assist veterans in understanding their Community Care eligibility and help them submit their federal applications.
Visit the Virginia DVS website at dvs.virginia.gov to locate your county's Veterans Service Office (VSO). Each Virginia county operates a VSO staffed with trained county veterans service officers who can review your military documents, help you complete VA Form 10-10EZ, and assist you in requesting Community Care services through the VA. These services are completely free—do not pay any third party for help with your application.
To access county VSO support, visit dvs.virginia.gov and use the "Find Your County VSO" tool to locate the office nearest you. Call the VSO directly and schedule an appointment. Bring your DD Form 214 or military discharge papers, photo identification, and any medical records showing why you need Community Care. The VSO can also help you request expedited processing if you meet certain medical criteria.
Alternatively, contact the Virginia Veterans Crisis Line at 1-800-273-8255, extension 1, for immediate assistance understanding your benefits options. Processing times through county VSOs typically range from 2-5 business days for initial intake and guidance. The VSO will then work with you to submit your federal application to VA.gov or direct you to do so online. No in-person visit to a VA facility is required; most Virginia veterans complete the application entirely online with VSO guidance.
Common Reasons for Denial
VA Community Care requests are most commonly denied when veterans are not yet enrolled in VA health care. The VA cannot refer veterans to Community Care if their enrollment application is still pending or has been rejected. Before requesting Community Care, ensure your VA health care enrollment is confirmed and active.
The second leading denial reason is that the veteran's healthcare need does not meet Community Care access standards. For example, if a VA facility can schedule you within 20 days of your preferred appointment date, you do not qualify under the wait-time standard. Similarly, if you live within 40 miles of a VA facility and your condition can be treated there, the VA may deny Community Care and direct you to the VA facility instead. To avoid this, clearly document why you need Community Care—such as your specific condition, current VA wait times, or distance limitations.
Another common reason for denial is incomplete or missing medical documentation. If you request Community Care but have not established a primary care relationship with the VA, the VA may request additional clinical information before approving the referral. Provide your complete medical history, current medications, recent lab results, and any specialist recommendations in your initial request.
Denials also occur when the requested service is not covered under Community Care. While Community Care covers most outpatient services, certain treatments—such as elective cosmetic surgery, experimental procedures, or services unrelated to service-connected conditions—are not authorized. Before requesting Community Care for a specific treatment, confirm that the service is VA-covered.
To build a stronger initial claim, establish your primary care relationship with the VA first. Schedule an initial VA primary care appointment before requesting specialists through Community Care. Document your current VA wait times in writing—obtain a letter from your VA medical center confirming scheduled appointment dates. If you have a long-standing relationship with a private provider, request that they document why continuity of care with them would benefit your health. Include a detailed explanation in your Community Care request of why VA facilities cannot meet your needs and how Community Care will improve your care outcomes.
If You Are Denied: The Appeals Process
If your VA Community Care request is denied, you have the right to appeal through the VA's standard appeals process. The VA must provide you with a written explanation of the denial that clearly states the reason(s) and your appeal rights. You typically have one year from the date of denial to file an appeal.
The three appeal lanes available for Community Care denials are: the Supplemental Claim lane, the Higher-Level Review (HLR) lane, and the Board of Veterans' Appeals (BVA) lane. Each has different timelines, requirements, and best-use scenarios.
The Supplemental Claim lane is best if you have new evidence—such as a letter from your private doctor explaining why you need Community Care, updated medical records, or documentation of longer VA wait times than originally reported. File VA Form 20-0995 (Supplemental Claim for Disability Compensation). There is no deadline to file a Supplemental Claim; you can file one at any time. Processing typically takes 4-6 months. This lane does not require you to wait; you can file while still pursuing other appeals.
The Higher-Level Review (HLR) lane is appropriate if you believe the VA made an error in interpreting your eligibility but have no new evidence to submit. File VA Form 20-0996 (Request for Higher-Level Review) within one year of the denial. An HLR must be completed within 90 days, though it often takes 60 days. An HLR officer will review the original decision to determine if it was legally or factually correct. You cannot submit new evidence in an HLR, only argument on existing record.
The Board of Veterans' Appeals (BVA) lane allows you to request a hearing before an independent administrative law judge. File VA Form 20-0996 or 20-0995 and request BVA review. The BVA typically schedules hearings 3-6 months after your request. You can appear by video or telephone. The BVA will issue a decision within 90 days to one year of your hearing. This lane is best when the legal interpretation of your eligibility eligibility is complex or when you want to present testimony.
Free help is available from accredited Veterans Service Organizations (VSOs) throughout Virginia. Your county Veterans Service Officer can represent you at no cost through any of these three appeal lanes. Contact the Virginia Department of Veterans Services at dvs.virginia.gov or call your county VSO. The VA also provides free representation through its Office of the General Counsel. Never pay a third party to represent you in appeals; this is illegal.
Get free help from your Virginia county Veterans Service Officer. Visit dvs.virginia.gov to find your VSO—they can guide your Community Care application at no cost. Never pay a third party for VA benefits assistance.
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 the difference between VA Community Care and VA health care, and do I need both?
VA Community Care is a program that allows the VA to send you to private doctors and hospitals instead of treating you at a VA medical facility. VA health care is your enrollment in the Veterans Health Administration system itself. You need to be enrolled in VA health care first to be eligible for Community Care. Think of it this way: enrollment in VA health care is the foundation; Community Care is an option within that system. You cannot receive Community Care unless you are already enrolled in VA health care. Once enrolled, you automatically qualify for Community Care if you meet the access standards (long wait times, distance from VA facility, specialized care needs). You do not need to do anything separate to be eligible for Community Care—your enrollment covers both. However, you will still have access to VA facilities even if you receive some care through Community Care. You can use both VA and Community Care providers depending on your needs.
How do I know if I qualify for Community Care based on wait times or distance?
The VA uses specific standards to determine Community Care eligibility. The primary standard is the 20-day rule: if the VA cannot schedule your appointment within 20 days of your preferred date, you automatically qualify for Community Care. The secondary standard is distance: if you live more than 40 miles from the nearest VA facility or more than one hour's travel time, you qualify for Community Care. When you request Community Care through VA.gov or by calling your VA medical center, the VA staff will check these standards against your location and the available appointment slots. You do not need to meet both standards—meeting either one qualifies you. If you are unsure, call the Community Care line at 1-844-842-4681 and provide your zip code; they can tell you immediately whether you meet the distance standard. For wait-time eligibility, your VA medical center can confirm current scheduling within five business days of your inquiry.
Are there copays or costs for Community Care services in Virginia?
No. There are no copays for Community Care services when you are an eligible enrolled veteran. This is a key benefit of the program: veterans pay nothing out-of-pocket at the point of service for Community Care appointments, procedures, diagnostic tests, or treatments. The VA pays the community provider directly from federal appropriations. However, veterans should note that some costs may still apply elsewhere in the VA system. If you receive a prescription from a Community Care provider and fill it at a VA pharmacy, you will owe the standard VA prescription copay (typically $0–$11 depending on your disability rating and income). If you fill the same prescription at a private pharmacy, the community provider's office can often process it with no copay through the VA's Community Care pharmacy network. Always ask the Community Care provider if they have an affiliated pharmacy to avoid copays.
How long does it take to get a Community Care appointment after I request one?
The VA aims to schedule Community Care appointments within 30 days of your request being approved. However, the actual timeline depends on several factors: how quickly the VA processes your request (typically 5-10 business days), the type of care you need, and the availability of community providers in your area. Once the VA approves your Community Care referral, they will match you with a participating community provider and send you the provider's contact information. You or the VA will then contact the provider to schedule your appointment. In urban areas like Northern Virginia or Richmond, appointments are often available within 2-3 weeks of approval. In rural areas, appointments may take longer if fewer providers participate in Community Care. You can check the status of your Community Care request anytime through VA.gov or by calling your local VA medical center's Community Care coordinator. If you experience delays beyond 30 days, contact your county Veterans Service Officer, who can advocate for expedited scheduling on your behalf.
Can I choose my own doctor through Community Care, or does the VA assign me to a provider?
The VA assigns you to a community provider based on their network, your location, and the type of care you need. You do not choose your provider before the VA makes the referral. However, you have significant input after the assignment. When the VA provides you with your assigned provider's name and contact information, you can contact that provider's office to confirm they accept your insurance and whether they are accepting new patients. If you have a specific private doctor you would like to see, you can request that the VA refer you to that provider if they participate in the Community Care network. The VA will verify whether your preferred provider is in the network and will attempt to make that referral if clinically appropriate. You can also request a different provider after your first appointment if you are not satisfied with the initial assignment. Keep in mind that not all private doctors participate in VA Community Care; only those contracted with the VA are available. Check VA.gov's provider finder tool to see which community providers accept Community Care referrals in your area.
What types of care are covered under VA Community Care in Virginia?
VA Community Care covers most outpatient healthcare services, including primary care, specialty consultations, mental health counseling, urgent care, diagnostic testing, physical therapy, and rehabilitation services. Specific covered services include office visits with doctors or nurse practitioners, laboratory tests and imaging (X-rays, MRIs, CT scans), mental health and substance abuse treatment, physical and occupational therapy, urgent and emergency care, specialty procedures such as joint injections or minor surgery, and preventive health screenings. Mental health services covered include individual counseling, group therapy, medication management, and crisis intervention. Notably, Community Care does not cover hospitalization; if you need inpatient admission, you will typically be admitted to a VA facility or receive emergency hospital care covered by emergency benefits. Experimental treatments, cosmetic procedures unrelated to service-connected conditions, and elective surgeries (such as cosmetic surgery) are generally not covered. Your local VA medical center can provide a complete list of covered services specific to your medical condition. When you request Community Care, ask the VA to confirm that your specific healthcare need is covered before you begin treatment with a community provider.
Related Benefits in Virginia
Sources & References
- 38 U.S.C. section 1703A — Authorizes VA to furnish care through community providers
- 38 C.F.R. section 17.3500 — Establishes Community Care access and eligibility standards
- Public Law 115-182 (MISSION Act of 2018) — Established the Community Care program framework and eligibility criteria
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 3 statutes. Last reviewed September 2026. Scheduled for re-verification by September 2027.
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