01. VA Community Care Program Overview
What Is the VA Community Care Program?
Community Care gives veterans access to healthcare through non-VA providers in the local community. Individuals must meet eligibility criteria to qualify for Community Care.
In general, veterans are eligible when the VA cannot provide the care they need. Through the program, healthcare is provided by community providers but paid for by the VA.
Community Care must be authorized by the VA before an eligible veteran can receive care from a local provider. Veterans are responsible for copays associated with non-service-connected care.
Veterans Community Care and Mesothelioma
Mesothelioma requires aggressive treatment for the best outcomes. Physicians have achieved advances in mesothelioma life expectancy with treatments such as HIPEC and cytoreductive surgery. However, very few VA hospitals provide these treatments.
The following VA facilities offer specialized mesothelioma care:
Without treatment, mesothelioma prognosis is usually poor. With the latest treatment options, some mesothelioma patients live more than 15 years after diagnosis. Thus, veterans with this cancer need to receive treatment from the most experienced mesothelioma specialists. The Veterans Community Care Program can help them do that.
Resources for Mesothelioma Patients
02. VA Community Care Program Eligibility
Who Is Eligible for the Veterans Community Care Program?
Veterans are eligible for Community Care (formerly known as Veterans Choice) if they meet any of the six criteria below.
VA Cannot Provide Specialized Care
If a veteran needs care not provided by any VA facility, they may qualify for Community Care.
Home State/Territory Lacks Full-Service VA Healthcare
Some states and U.S. territories do not have a full-service VA medical facility. If a veteran lives in one of these states or territories, they would be eligible for Community Care.
Veteran Meets Certain Grandfathered Distance Characteristics
The Community Care Program was preceded by the Veterans Choice Program. Veterans could qualify for care under the Choice Program by meeting distance criteria. Those eligibility criteria were grandfathered into the Community Care Program.
To qualify using distance, a veteran must:
- Have lived more than 40 miles from the closest VA medical facility on June 6, 2018
AND - Still live in a location more than 40 miles from the closest VA medical facility
AND - Currently live in Alaska, Montana, North Dakota, South Dakota or Wyoming
VA Cannot Provide Care Within Time or Distance Constraints
Veterans qualify for the program if the VA cannot schedule an appointment within specified time standards for drive time and wait times.
Average Drive Times to Facilities:
- 30 minutes for primary care, mental health and non-institutional extended care
- 60 minutes for specialty care
Access Standards for Appointment Wait Times:
- 20 days for primary care, mental health and non-institutional extended care
- 28 days for specialty care
It Is in the Veteran’s Best Interest
If the referring physician believes local care is in the veteran’s best medical interest, the veteran qualifies for Community Care.
Existing VA Care Does Not Meet Quality Standards
The VA may determine a certain line of care does not meet quality standards. If a veteran needs this type of care, they qualify for Community Care.
03. Process for Receiving Community Care Benefits
What Is the Process for Receiving Community Care Benefits?
- Veterans must confirm eligibility for the program before scheduling appointments or treatment.
- The veteran or VA staff must schedule an appointment with a provider in the VA’s Community Care network.
- The veteran receives care.
- The provider sends a bill to a third-party administrator or the VA for payment.
- Prescription coverage is provided, but long-term prescriptions must be filled at a VA facility.
04. Community Care vs. Choice Program
How Does the Veterans Community Care Program Compare to the Veterans Choice Program?
The Community Care Program is an updated version of the Veterans Choice Program (VCP). The VCP expired in 2019. However, its functions were replaced under the VA Mission Act of 2018. The Mission Act created the Veterans Community Care Program.
The eligibility criteria for Community Care appear wider than those of the VCP. However, the healthcare benefits are approximately the same.
Veterans diagnosed with mesothelioma or other asbestos-related illnesses may be eligible for other VA benefits. A mesothelioma lawyer can help veterans file a VA claim and investigate other compensation options.
