ARTICLE
Under the VA MISSION Act of 2018, Veterans will have better access and greater choice in health care either at VA or a community provider through improved eligiblity criteria. The new criteria are designed to ensure that Veterans currently eligible for community care, especially those who are wait-time or drive-time eligible, have access to the care they need. Veterans should contact their local VA facility to determine if they are eligible for community care. The new eligibility criteria include: Veterans must receive approval from VA prior to obtaining care from a community provider in most circumstances. Veterans must either be enrolled in VA health care or be eligible for VA care. Eligibility for community care will continue to be dependent upon a Veteran’s individual health care needs or circumstances. VA staff members generally make all eligibility determinations. Veterans will usually have the option to receive care at a VA medical facility regardless of their eligibility for communtiy care. Meeting any one of six eligibility criteria below is sufficient to be referred to a community provider—a Veteran does not have to meet all of them. Veteran Needs a Service Not Available at a VA Medical Facility. Veteran Lives in a U.S. State or Territory Without a Full-Service VA Medical Facility (Texas HAS full-service facilities). Veteran Qualifies under the “Grandfather” Provision Related to Distance Eligibility for the Veterans Choice Program. Two requirements that must be met in every case: Veteran was eligible under the 40-mile criterion under the Veterans Choice Program on the day before the VA MISSION Act was enacted into law (June 6, 2018), and Veteran continues to reside in a location that would qualify them under that criterion. If both of these requirements have been met, a Veteran may be eligible if one of the following is also true: Veteran lives in one of the five States with the lowest population density from the 2010 Census: North Dakota, South Dakota, Montana, Alaska, and Wyoming, or Veteran: lives in another State, received care between June 6, 2017, and June 6, 2018, and requires care before June 6, 2020 VA Cannot Furnish Care within Certain Designated Access Standards. In general this may apply if the average drive time is 30 minutes or more for primary careand more than 60 minutes for specialty care; or if an appointment date exceeds 20 days for primary care or 28 days for specialty care (unless the veteran agrees to a longer wait). It Is in the Veteran’s Best Medical Interest. A Veteran may be referred to a community provider when the Veteran and the referring clinician agree that it is in their best medical interest to see a community provider. A VA Service Line Does Not Meet Certain Quality Standards. Veterans who are eligible for community care will continue to have the choice to receive care at VA or a community provider. Source: https://www.va.gov/COMMUNITYCARE/docs/pubfiles/factsheets/VA-FS_CC-Eligibility.pdf?sfns=mo
Veterans who are eligible for community care will continue to have the choice to receive care at VA or a community provider.