The Veterans Community Care Program: Background and Early Effects

The Veterans Health Administration (VHA), part of the Department of Veterans Affairs (VA), provides health care to eligible veterans using a combination of VHA and non-VHA providers and facilities. Until a few years ago, VHA generally allowed patients to seek community care (that is, it referred patients to outside providers) on an exception basis. In recent years, however, major legislative and VA-led changes to VHA’s policies have increased opportunities for veterans to seek community care at VHA’s expense. Currently, the Veterans Community Care Program (VCCP) allows veterans to see outside providers on the basis of several factors, including the local availability of VHA care and the circumstances of individual veterans. In this report, the Congressional Budget Office examines some of the effects of VCCP.

Between 2014 and 2019, about two million veterans, or almost one-quarter of VHA enrollees, were authorized to use community care under VCCP’s predecessor, the Veterans Choice Program. The VA MISSION Act (Public Law 115-182), which was enacted in 2018, created VCCP to replace the Veterans Choice Program as well as most agreements that VA medical centers had with local private providers; it also consolidated other community care programs. The MISSION Act diverges from previous VA policy that used community providers as a last resort. Now, eligible veterans may choose community care even if a VHA provider is available as long as they meet specific requirements.

In examining the effects of VA’s changing policies toward community care, CBO determined that since 2014, the number of veterans using community care has increased and average wait times in VHA facilities have declined and remained generally below those in the private sector. CBO estimates that VHA’s costs for community care grew from $7.9 billion in 2014 to $17.6 billion in 2021. (All dollar values are expressed in 2021 dollars unless otherwise stated.)

In addition, CBO found that prioritizing veterans’ access to community providers may affect other aspects of patient care and VHA’s ability to deliver it: It is more difficult for VHA to coordinate care outside of its own facilities, and VHA has little control over the quality of care that veterans receive from community providers. Finally, increasing access to community care may reduce utilization of VHA facilities that have sufficient capacity, which could lead to higher costs per veteran if VHA cannot close or consolidate them.