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) Drive time exceeds 30 minutes for primary/mental health care, OR 60 minutes for specialty care, from your home to the nearest VA facility offering that service. (2) Wait time exceeds 20 days for primary/mental health, OR 28 days for specialty care, at your VA facility. (3) The VA cannot provide the specific service you need (rare specialty, niche surgery, etc.). (4) Your VA care team and you agree community care is in your best medical interest. (5) The VA facility does not meet specific quality standards for the service. (6) You qualify under "grandfathered" Veterans Choice Program criteria from before 2019. Most vets qualify under #1 or #2. Document drive time + wait time before requesting.
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)
Standard authorization: 5-10 business days. Urgent authorization (mental health crisis, urgent surgery): 1-3 business days — explicitly request expedited review when submitting. Once authorized, VA contracts with TriWest (West region) or Optum Public Sector Solutions (East region) to manage the appointment. They will mail or call you with: (a) the approved provider; (b) the appointment scheduling instructions; (c) the authorized period (usually 60-90 days). For mental health emergencies: the VA must authorize emergency mental health community care immediately under the COMPACT Act (2020).
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, your CVSO can escalate to the VISN (regional VA network) office. For systemic denials, contact your congressional rep — community care denials are a frequent congressional inquiry topic and often resolved within days when escalated.
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 the VA mental health clinic has a 30+ day wait, you qualify for community mental health care under MISSION Act + COMPACT Act.
- Emergency care: if you go to a non-VA emergency room for a service-connected condition, the VA pays under 38 USC 1725 and 1728. File VA Form 10-583 within 90 days. Different from MISSION Act — emergency reimbursement is automatic for service-connected conditions.
- 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. The VA must authorize community mental health care for crisis under the COMPACT Act of 2020 — no enrollment required, no service-connection required.