What You Need to Know About the New VA Community Care Program

If you’re a veteran who lives in an isolated area, or who is suffering from a rare medical condition, you were probably enrolled in the Veterans Choice Program (VCP), which enabled qualifying veterans to receive medical care from private doctors and hospitals at the VA’s expense. In June 2019, however, the program ended. It has been replaced by the VA Community Care Program (CCP), which generally expands access to care at private healthcare providers for veterans. If you qualified for the choice program, it is likely that you also qualify for the Community Care Program.

When you’re a veteran, you rightfully expect your country to stand behind you when you fall on hard times. This need couldn’t be more urgent when you’re suffering from a medical condition caused by your military service. Unfortunately, the VA sometimes fails to meet the duty it owes to our country’s veterans, and denies them essential benefits. In these situations, the veterans benefits lawyers of Jackson & MacNichol can help. If you have been wrongfully denied your veterans benefits, call us today at 1-800-524-3339 for a free consultation.

The Veterans Choice Program Has Been Replaced With VA Community Care

In the months preceding the end of the VCP program, the VA began transitioning veterans’ authorizations to the new program so that they could continue to receive the care they need from their community providers. In some instances, veterans faced billing issues during the transition process–and sometimes even the threat of debt collections over unpaid medical bills. The VA encourages veterans to continue to receive essential medical care, and to contact the community care program at 1-877-881-7618 to resolve any billing issues.

The Community Care Program has expanded eligibility for private healthcare to veterans who are either enrolled or eligible for VA healthcare. As a veteran, you may receive community care when:

• You need urgent care–No pre-authorization is required, but you may be responsible for the copay cost of care at an urgent care clinic.
• The VA can’t provide you the care you need–If you have specialized medical needs, it’s possible that the VA hospital can’t care for you. In this case, the VA may pay for you to receive treatment at a private healthcare provider.
• The nearest VA provider is too hard to reach–If it takes longer than 30 minutes to get to the closest VA hospital for primary care, or 60 minutes for specialty care, then you are eligible for community care. Additionally, if you live in a US State or territory without a full service VA medical center, you are eligible. Finally, if you were previously eligible for VCP because of driving distance, it’s likely that you will be “grandfathered in” into the new program.
• You can’t make an appointment–If it takes longer than 20 days to get an appointment at the VA hospital to receive primary care, you may go to a community provider instead. And if the wait time for a specialty care appointment is longer than 28 days, you can seek community care.
• The local VA Hospital’s standards are too low–The VA will have internal controls to gauge the quality of the services its hospitals provide. If your local hospital isn’t up to standards, you can go to a private hospital.

In all instances except for urgent care, you need to get authorization from the VA before receiving community care. And even if you were previously enrolled in VCP, it would be a good idea to ensure that you have been successfully transferred to the Community Care Program before making any appointments at a private healthcare provider.

A Veterans Benefit Lawyer Can Help

At Jackson & MacNichol, we closely follow any legislative or regulatory developments that could affect the rights and interests of our clients. Although its effectiveness remains to be seen, the Community Care Program’s goals of increasing patient choice and improving the quality of care at VA hospitals is commendable. Should you have trouble getting access to the benefits to which you are entitled as a veteran of the armed forces, do not hesitate to call us at 1-800-524-3339 for a free consultation about your case.