How to request MISSION Act community care — when the VA pays for non-VA providers
The VA MISSION Act of 2018 (38 USC § 1703, 38 CFR § 17.4010) lets veterans receive care from non-VA community providers when VA cannot deliver care within drive-time and wait-time standards. Critical for rural veterans, specialty care, and emergency mental health. 5 steps to request, eligibility criteria, and what to do if VA denies.
What you'll need
- VA enrollment (any priority group)
- Phone (call your VA primary care team)
- Map/clock for drive-time + wait-time documentation
- List of preferred community providers (optional but helpful)
- Free CVSO if VA denies the request
Step-by-step
Step 1: Confirm you are eligible under one of six MISSION Act criteria
Per 38 CFR 17.4010, you qualify if ANY ONE of these is true: (1) VA does not offer the care or service you need. (2) You live in a state or territory without a full-service VA medical facility. (3) You qualified under the old 40-mile rule as of June 6, 2018 and live in Alaska, Montana, North Dakota, South Dakota or Wyoming. (4) VA cannot schedule your care within its access standards — an average drive of 30 minutes for primary and mental health care or 60 minutes for specialty care, or a wait of 20 days for primary and mental health care or 28 days for specialty care. (5) You and your VA provider agree community care is in your best medical interest. (6) The VA service line you need does not meet VA quality standards. Write down your drive time and the next available VA appointment before you ask.
Step 2: Request community care via your VA care team
Call your VA primary care team (or specialty clinic if requesting specialty care) and explicitly say: "I am requesting community care under the MISSION Act based on [drive time / wait time / specialty unavailable / best medical interest]." Your VA team submits a community care consult on your behalf. You can also request via VA.gov secure messaging or in-person at any VA facility. Tip: name the eligibility criterion explicitly — vague requests get returned with a default "VA can provide care" stamp. If your team pushes back, escalate to the VA Patient Advocate (every facility has one — ask the front desk).
Step 3: Wait for authorization (or request expedited authorization for urgent cases)
For urgent needs, say so when you ask. Once authorized, the community care network administrator for your region (Optum for Regions 1–3, TriWest for Regions 4–5) or VA staff helps arrange the appointment. You will get: (a) the approved provider; (b) scheduling instructions; (c) the authorized period. If you are in an acute suicidal crisis, you can go to any VA or non-VA facility for free emergency care under the COMPACT Act (in effect since January 17, 2023) — including up to 30 days of inpatient or crisis residential care and up to 90 days of outpatient care; service requirements apply.
Step 4: Schedule your community care appointment
You can request a SPECIFIC community provider if they are in the VA network — call TriWest/Optum and ask. If not in-network, ask if they can be added (often yes). If you have an existing community provider relationship (e.g., long-term therapist), name them in your request. Bring your VA authorization letter to the appointment — the provider needs it to bill VA. Do NOT pay out-of-pocket if you have an authorization — VA pays the provider directly. Co-pays may apply per your VA priority group (Priority 1 = no co-pays).
Step 5: If VA denies the community care request — appeal
Common denial reason: "VA can provide care within standards" — but this is sometimes wrong. Rebut by documenting: (a) actual drive time on your specific date (Google Maps screenshot at the time of day you would travel); (b) actual VA wait time (call the VA scheduling line and document the next available appointment); (c) any prior VA visit cancellations or rescheduling. File a Patient Advocate complaint at your VA facility AND file a written request for reconsideration with your community care office. If the denial stands, you can use VHA's clinical appeals process (these decisions are not appealed to the Board of Veterans' Appeals), and your CVSO can help you escalate to the VISN (regional VA network) office. Your congressional office can also make an inquiry.
Critical tips
- MISSION Act community care is a RIGHT, not a favor. You meet the criteria → VA must authorize. Don't accept "we don't do that" as an answer.
- Mental health is EXPLICITLY covered. If VA cannot schedule mental health care within 20 days (or within a 30-minute average drive), you can qualify for community mental health care.
- Emergency care at a non-VA ER: VA may pay under 38 USC 1728 (service-connected conditions) or 1725 (other conditions). Tell VA within 72 hours of the visit and file the claim as soon as you can — deadlines apply (generally 2 years for service-connected care, 90 days for other care). Payment is not automatic.
- Veterans rated 50%+ service-connected pay NO co-pay for community care. Even Priority 8 vets get community care — co-pay rules differ but eligibility is the same.
- In crisis: 988 + Press 1. In an acute suicidal crisis you can go to any VA or non-VA facility for free emergency care under the COMPACT Act — VA enrollment is not required, but service requirements apply.