VA Community Care for Women Veterans
When the VA cannot provide timely or nearby care, the MISSION Act requires it to send you to an approved community provider — at no extra cost to you.
Community Care is not a separate VA program — it is a safety net built into the system by the MISSION Act of 2018. When the VA cannot meet certain access standards, it is required to send you to an approved community provider and pay for the care itself. You do not pay extra.
This matters enormously for women veterans. If your VA medical center does not have a gynecologist, mammography suite, or specific specialist you need — or if the wait for an appointment is unreasonably long — Community Care is how you get that care locally without paying out of pocket.
The key is knowing when you are eligible for Community Care and how to request it. The six triggers below are specific and measurable. If any one of them applies, you have the right to see an outside provider through the VA.
Non-VA providers
When the VA cannot provide timely or nearby care, the MISSION Act requires it to send you to an approved community provider — at no extra cost to you.
Use the eligibility and access steps on this page to connect with this service without leaving the guide.
Understanding Community Care
Wait-time trigger — 20 or 28 days
If the VA cannot schedule you within 20 days for an existing condition or 28 days for a new condition, you are eligible for Community Care. The clock starts from the date the VA receives the referral or the veteran's request.
Drive-time trigger — 30 or 60 minutes
If your nearest VA facility offering the service is more than 30 minutes away (primary care, mental health) or 60 minutes away (specialty care), you qualify. The VA measures average drive time, not straight-line distance.
Service not available
If the VA does not provide a specific service you need — at your facility or any nearby VA facility — Community Care fills the gap. This is common for women's specialty services like pelvic-floor therapy, fertility treatment, or specific gynecological procedures.
Best medical interest
Your VA provider can refer you to a community provider when it is in your best medical interest — for example, when a local specialist has particular expertise in your condition or when travel would be medically harmful.
VA facility quality standards
If a VA facility does not meet quality standards established by the VA for a particular service, veterans using that service may be referred to Community Care.
State without a full-service VA medical center
Veterans in a state without a full-service VA medical center have expanded Community Care access under the MISSION Act.
Do you qualify for Community Care?
You are enrolled in VA health care.
At least one of the six MISSION Act triggers applies to your situation (wait time, drive time, service unavailability, best medical interest, quality standards, or state without a full-service VAMC).
Your VA provider or care team submits a referral for Community Care — you generally cannot self-refer.
The community provider must be in the VA's approved network (managed by contractors like Optum or TriWest).
Prior authorization from the VA is required before receiving care — the VA must approve the referral before you see the community provider.
Emergency care is the exception — in a medical emergency, go to the nearest emergency room and notify the VA within 72 hours.
Not sure whether you qualify? Eligibility details can be complex. An accredited representative can confirm exactly where you stand before you invest time in applications.
What Community Care actually gives you
The full scope of the referred service
Whatever service the VA cannot provide — a mammogram, gynecological surgery, orthopedic procedure, mental health treatment — is covered at the community provider under the same terms as VA care.
No additional out-of-pocket costs
You do not pay the community provider directly. The VA pays through its Community Care contracts. Copays, if applicable, are based on your VA priority group, not the community provider's rates.
Follow-up care included
The referral covers the approved course of treatment, including necessary follow-up visits with the community provider. Your VA care team coordinates the handoff back when treatment is complete.
Travel reimbursement may apply
Depending on your eligibility, you may qualify for VA Beneficiary Travel reimbursement for the mileage to and from the community provider.
What this means for you
Community Care exists because the VA knows it cannot do everything at every facility — and women's health is one of the areas where gaps appear most often. If your VA does not have a gynecologist, does not perform the procedure you need, or cannot see you for weeks, you are not stuck. The MISSION Act gives you a right to see a local provider, and the VA pays. The barrier is usually not knowing you can ask — now you know.
Getting Community Care, step by step
Talk to your VA provider about why you need outside care
Explain the barrier — long wait, long drive, service not available at your VA, or a specialist recommendation. Your provider initiates the Community Care referral.
Ask your VA care team to check access standards
The VA compares your wait time and drive time against the MISSION Act thresholds. If you exceed either standard, the referral should be approved.
Get prior authorization before seeing the community provider
The VA must approve the referral and identify an in-network community provider before your appointment. Do not go to an outside provider without VA authorization — you may be billed directly.
Confirm the community provider is in-network
Check that the provider is in the VA's Community Care network (managed by Optum or TriWest depending on your region). Your VA care team or patient advocate can confirm this.
Share results back with your VA team
After your community care appointment, make sure records are shared with your VA care team so your treatment is coordinated. Most in-network providers send records directly, but confirm with both sides.
Women Veterans Call Center
For Community Care eligibility, referral questions, and help navigating the MISSION Act
1-855-829-6636What trips women veterans up
Going to a community provider without VA prior authorization — without approval, you may receive a bill the VA will not pay.
Assuming you are stuck with long waits — if the VA cannot see you within access standards, Community Care is your right under the MISSION Act.
Not asking about Community Care for women's services — mammography, GYN procedures, pelvic-floor therapy, and fertility treatment are common referrals when your VA facility lacks the service.
Choosing an out-of-network provider — the community provider must be in the VA's approved network. Confirm before scheduling.
Failing to share records back to the VA — Community Care appointments need to feed back into your VA medical record so your care team stays coordinated.
Not using Community Care for mental health — if wait times for a therapist or psychiatrist at your VA exceed access standards, you can see a community mental health provider.
Community Care: your questions answered
Can I choose my own community provider?
You can express a preference, but the provider must be in the VA's approved Community Care network (Optum or TriWest depending on your region). Your VA care team will identify available in-network providers for you.
Do I have to pay the community provider?
No. The VA pays the community provider directly through its contracts. If copays apply based on your priority group, those are handled through the VA, not at the community provider's office.
What if the VA denies my Community Care referral?
If you believe you meet the MISSION Act access standards and your referral is denied, contact your VA patient advocate. You can also request a clinical appeal if you believe the denial is incorrect.
Does Community Care cover emergencies?
In a medical emergency, go to the nearest emergency room. Notify the VA within 72 hours so it can coordinate payment. You do not need prior authorization for genuine emergencies.
How do I know if my drive time qualifies?
The VA uses average drive time, not straight-line distance. The thresholds are 30 minutes for primary care and mental health, and 60 minutes for specialty care. Your VA care team or patient advocate can check your specific situation.
What happens after my community care treatment is done?
Your care transitions back to your VA team. The community provider sends records to the VA, and your VA primary-care provider resumes coordination. If follow-up community visits are needed, they must be included in the original authorization or a new referral submitted.
See every healthcare service available to women veterans, or estimate the rating that could expand your VA health care access.
Not sure where to start?
Whether you need help enrolling, understanding what the VA covers, or connecting a health condition to a disability claim, a free review of your situation can put you on the right path.
