VA MISSION Act launch: Here's who's eligible to see private doctors

Abbie Bennett
May 31, 2019 - 3:16 pm

ID 76967936 © Sherry Young | Dreamstime.com

The VA MISSION Act launches June 6 as the CHOICE Act expires, expanding opportunities for veterans to seek care from private, non-VA or Department of Defense doctors. 

There are several criteria for who qualifies to seek "community care," though. To be able to receive care from a private provider, at least one of the following criteria must be met, according to the VA:

  • The VA does not offer the service a veteran needs. Veterans who need services not offered by the VA automatically are eligible to get that care through a private doctor.
  • The veteran lives in a state without a full-service VA facility, such as New Hampshire, Alaska or Hawaii. Those veterans automatically qualify for private care.
  • Veterans grandfathered in under the CHOICE Act. Veterans who live 40 miles from a primary care physician in the VA system, were able to access private doctors under CHOICE. Those veterans, so long as they have used that care in the last two years, remain eligible for private care.
  • If it is in the veteran’s best medical interest to receive private care, that veteran will be eligible. That decision must be made jointly by the veteran and their VA doctor.
  • If a VA facility falls below certain standards, the veterans served by that facility will be eligible for private care.
  • If a veteran lives farther than a 30 minute drive time from a VA primary care doctor or mental health professional, they are eligible for private care. For specialists, the drive time is 60 minutes.
  • If the VA cannot provide primary care or mental health appointments within 20 days, or specialty appointments within 28 days, that veteran qualifies for private care.

Veterans do NOT have to establish eligibility or do anything different to keep seeing the doctors they already see or to continue receiving the care they do now.

Any veteran enrolled at the VA -- even if they also qualify for care through the Department of Defense -- is eligible for private care if they fall under at least one of the 6 criteria, VA officials said. 

If a VA doctor and veteran don’t agree about the veteran seeking private care, the veteran’s case will be reviewed and there will be a clinical appeal through a patient advocate at the VA. If the issue is about whether or not they are eligible for private care, that is an expedited appeal that is supposed to be considered within 72 hours. 
The chief of staff at the facility will contact the veteran directly with the decision.

For more information on the MISSION Act and changes you can expect, go to www.missionact.va.gov