How the VA Referral Process Works (Including Community Care)

VA runs on referrals. Almost every specialist visit, inside VA or outside it, begins with a request from your VA provider. VA calls the request a consult. The consult goes to the specialty clinic or the facility's community care office, gets reviewed, and becomes either a VA appointment or a community care authorization.

The community care side is the Veterans Community Care Program, created by the VA MISSION Act of 2018 and launched June 6, 2019. Its rules are in the Code of Federal Regulations at 38 CFR 17.4000 through 17.4040: definitions in 38 CFR 17.4005, eligibility in 38 CFR 17.4010, and the drive-time and wait-time standards in 38 CFR 17.4040.

You need to be enrolled first; the VA health care enrollment guide walks through Form 10-10EZ. If you have no assigned provider yet, start with finding a VA primary care provider. Here is the process as VA describes it on its referrals and scheduling page:

1. Ask your VA provider for a referral. If you want a community provider, say so; you can search for one yourself or ask your VA team to find one.
2. VA reviews the consult. Staff confirm the clinical need and check community care eligibility. VA says this can take up to 14 days.
3. VA schedules you, or you schedule yourself. If you self-schedule community care, tell your VA health care team within 14 days.
4. Read your authorization letter. It lists an authorization number, the provider, the care approved and how long you can keep getting it.
5. Go to the appointment. VA shares your medical records with the community provider.
6. Track follow-on care and the expiration date. A new specialty or more visits than authorized usually means a new consult.

You cannot refer yourself, and a private doctor cannot refer you into VA. The request has to come from a VA clinician, usually your primary care or mental health provider. Be specific about what has changed and what you have tried; the consult your provider writes is what the reviewer reads. The VA specialty clinic directory explains what each clinic treats.

You can also ask for community care at this step. Under 38 CFR 17.4010(a)(5), you and your referring clinician can decide together that community care is in your best medical interest, based on distance, how soon you can be seen, continuity with a provider you already have, or an unusual or excessive burden in getting to VA. Since May 19, 2025, that joint decision no longer needs sign-off from a second VA doctor; VA removed that step under the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act (Public Law 118-210, enacted January 2, 2025).

Once the consult is entered, the receiving clinic or community care office reviews it for clinical accuracy, and schedulers check whether VA can offer an appointment within the access standards below. VA says the review can take up to 14 days. VA's customer service guide (PDF) tells veterans not to schedule a community appointment until VA contacts them with the approved consult.

How to check the status. Sign in to My HealtheVet on VA.gov (ID.me or Login.gov), where the appointments tool lets you request community care appointments and send a secure message to your care team or community care office. You can also call your facility's community care office, or the national Community Care Contact Center at 877-881-7618 (TTY: 711), Monday through Friday, 8:00 a.m. to 9:00 p.m. ET.

Watch out: VA's customer service guide says that if you do not schedule your community care appointment within 14 business days of approval, you will need a new consult. VA will try to reach you up to 3 times, so keep your phone number current.

You must be enrolled in or eligible for VA health care, and VA must approve the care before you get it (urgent and emergency care are the exceptions, covered below). Beyond that, VA's general care eligibility page says you may be eligible if at least 1 of these is true:

• You need a service that VA does not provide at any VA health facility.
• You live in a state or territory with no full-service VA health facility.
• You and your VA provider agree that care from an in-network community provider is in your best medical interest.
• VA cannot provide the service in a way that meets its quality standards.
• You qualified under the 40-mile distance rule as of June 6, 2018 under the Veterans Access, Choice, and Accountability Act of 2014 (the old Veterans Choice Program), and you live in Alaska, Montana, North Dakota, South Dakota, Wyoming or another grandfathered location, or
• VA cannot provide the care you need within its drive-time and wait-time standards.

The last item is the one most veterans use, and the one most often misquoted.

The access standards live in 38 CFR 17.4040. Drive time is the average driving time from your home to the VA facility that could provide the care. Wait time runs from the date of your request.

Source: https://www.ecfr.gov/current/title-38/chapter-I/part-17/subpart-P/section-17.4040, in effect June 6, 2019 and unchanged as of September 2026.

VA only needs to miss 1 standard. If the nearest VA cardiology clinic is 45 minutes away and the first opening is in 6 weeks, you are eligible for community care because VA missed the 28-day wait standard. The standards do not make VA pay for a provider you picked before the referral was approved.

An approved community care consult produces an authorization letter listing your authorization number, the in-network provider you are approved to see, a description of the care approved, and the time period covered. Bring it to your first appointment. The provider bills VA for authorized care.

Community Care Network (CCN). Community providers work through a contracted network in 5 regions. According to VA's CCN regions page, Optum Serve runs Regions 1 through 3 (East, Midwest and Southeast) and TriWest Healthcare Alliance runs Regions 4 and 5 (West, Texas, Pacific territories and Alaska).

Choosing a doctor. You can pick your own provider as long as the provider is in the network for your region. Use the community provider search in VA's facility locator, or ask your VA care team.

What is changing in 2026. On December 15, 2025, VA announced it was rebidding the CCN contracts, which expire in 2026, so that multiple health plans can compete. As of September 2026, VA has not announced new administrators or start dates. The eligibility rules and access standards are set by regulation and are not part of the contract change.

Many specialty authorizations used to expire after 90 to 180 days, so a veteran mid-treatment needed a new consult. On August 4, 2025, VA announced yearlong authorizations for 30 standardized service types, including cardiology, dermatology, endocrinology, gastroenterology, neurology, oncology, ophthalmology, orthopedics, pain management, physical medicine and rehabilitation, podiatry, psychiatric services, pulmonary, rheumatology, sleep medicine and urology. For those services you get 12 months of care at VA expense before reauthorization.

Your letter still controls. If the expiration date is near and treatment is not finished, ask the community provider to request continued care from VA early.

Bridge to your claim: Records from a community specialist come back to VA after each visit. A diagnosis, imaging report or range-of-motion measurement from that specialist can become evidence for a disability compensation claim or a request for an increase. Ask for a copy of the visit note, and see medical evidence requirements for how VA weighs treatment records. A VA-accredited representative can help with a claim for free.

A stalled consult usually means the clinic has not reviewed it, the scheduler cannot reach you, or the community care office is waiting on eligibility information. Work up the ladder in this order.

1. Call the clinic or the community care office. Ask for the consult status and the date it was entered; the 14-day review clock and the 20- or 28-day wait standard both start with dates you can cite.
2. Send a secure message to your primary care team through My HealtheVet. A written record helps if you escalate.
3. Contact your facility's patient advocate. VA's patient advocate page says advocates take your concerns to the staff who can resolve them and make sure you receive the benefits you are entitled to by law. The number is on your facility's VA.gov page.
4. Call the Community Care Contact Center at 877-881-7618 (TTY: 711), Monday through Friday, 8:00 a.m. to 9:00 p.m. ET.

If community care is denied. Ask your provider to document the reason and re-check the 6 criteria, especially drive time and the first available VA appointment date. Under 38 CFR 17.4010(d), eligibility decisions go through VA's clinical appeals process at the facility. They cannot be appealed to the Board of Veterans' Appeals, so the patient advocate and clinical appeal are the path, not a Notice of Disagreement.

Urgent and emergency care do not need a referral. If you are enrolled and have used VA or in-network care in the past 24 months, you can use an in-network urgent care clinic without a consult; see VA urgent care options. For an emergency, go to the nearest emergency department and make sure VA is notified within 72 hours; the emergency room coverage guide explains how.

VA's yearlong-authorization list doubles as a map of what gets referred out most: cardiology, dermatology, gastroenterology, neurology, orthopedics, ophthalmology, pain management, podiatry, sleep medicine and urology. Psychiatric services are on the list too, under the 20-day mental health standard. The VA health care coverage guide covers what VA pays for once you get there.

Community care is federal, but many states fill gaps around it: rides to medical appointments through county veterans service offices, state veterans homes for long-term care, and state-funded mental health and peer support programs that need no VA referral.