VA Community Care for Mental Health and Substance Use Treatment

VA Community Care lets eligible veterans receive care from a non-VA provider, paid for by VA. The eligibility rules come from the MISSION Act. This page is about the practical part — how to get a referral, what an authorization actually covers, and how to avoid the billing problems that catch people out.

Am I eligible?

You must be enrolled in VA health care (or otherwise eligible for VA care), and meet at least one of six pathways:

• VA does not offer the service you need
• You live in a state or territory without a full-service VA medical facility
• You are grandfathered under the old 40-mile Choice criterion
• VA cannot meet its access standards — more than 20 days for mental health or primary care, more than 28 days for specialty care; or an average drive time over 30 minutes for mental health or primary care, over 60 minutes for specialty care
• You and your VA clinician agree it is in your best medical interest
• VA cannot provide care meeting its own quality standards

For mental health and substance use treatment, the access standards pathway is the one that most often applies — these are the services with the longest waits, and mental health benefits from the more generous 20-day, 30-minute thresholds.

Recent reforms under the Dole Act also simplified referrals for non-VA mental health care where your VA clinician agrees community care is the better option, removing a layer of secondary review that used to slow things down.

Getting a referral, step by step

1. Confirm your enrollment. Not enrolled? Apply. Eligibility is broader than many veterans assume, particularly after recent toxic-exposure expansions.
2. Ask your VA care team. Community care requires a VA referral. Tell your primary care provider, your VA mental health clinician, or the SUD program what you need — therapy, psychiatric medication management, intensive outpatient substance use treatment, PTSD treatment.
3. Name the grounds explicitly. Do not assume it will be offered. Useful phrasing:
   • “The soonest appointment is 42 days out. That exceeds the 20-day mental health access standard. I would like a community care referral.”
   • “The drive from my home is over an hour each way, which exceeds the drive time standard for mental health care.”
   • “I need intensive outpatient treatment three evenings a week. That is not feasible at this distance. I believe community care is in my best medical interest.”
4. Get the authorization in writing. It should specify the provider or network, the type of care, the number of visits, and the date range. Keep a copy.
5. Verify the provider is in the VA community care network before your first visit. VA contracts through third-party administrators, and a provider who takes your commercial insurance is not automatically in the VA network.
6. Confirm the referral reached the provider. Referrals get lost. A phone call at this stage prevents weeks of delay.
7. Watch your visit count and renew early. Authorizations run out, and the gap while a renewal is processed is where treatment gets interrupted. Ask about renewal when you are two-thirds through your authorized visits.

Billing: how to avoid problems

• Get authorization before care, except for in-network urgent care and emergencies. Unauthorized care may not be covered, and you may be billed directly.
• You should not be billed for authorized community care beyond any applicable VA copay, which depends on your priority group and the type of care. The provider bills VA, not you.
• If you get a bill anyway, which happens, do not pay it and do not ignore it. Contact the provider’s billing office and the VA community care office at your facility, and reference your authorization number. Unresolved community care billing has been sent to collections in the past — document every call.
• Emergency care is handled under separate rules. Go to the nearest emergency room, and notify VA as soon as you reasonably can — within 72 hours is the usual guidance — because timely notification affects coverage.
• Do not use your commercial insurance for authorized community care without checking, as this can create a coordination-of-benefits mess.

What community care can cover for substance use and mental health

• Individual and group therapy
• Psychiatric evaluation and medication management
• Medication for alcohol and opioid use disorder
• Intensive outpatient and partial hospitalization programs
• Residential substance use treatment
• Medically supervised withdrawal
• PTSD treatment, including prolonged exposure, CPT and EMDR
• Dual-diagnosis treatment for co-occurring conditions
• Telehealth, where the provider offers it and VA authorizes it

Southern California specifics

Riverside and San Bernardino counties cover a vast area. For most residents the nearest full-service VA medical centers are Loma Linda and Long Beach, with community-based outpatient clinics spread unevenly across the region. From Desert Hot Springs, the Coachella Valley, the high desert, or Blythe, drive times routinely exceed both the 30-minute and 60-minute thresholds.

This is precisely what the drive time standard is for. If you are being asked to make a two-hour round trip several times a week for intensive outpatient treatment, that is not a workable plan, and it is a strong basis for a community care referral.

Vet Centers are a separate and often faster route. They provide free readjustment counseling, individual and group therapy, and MST counseling with broad eligibility and no community care authorization needed. Their records are kept separate from VA medical records.

If you get stuck

• VA patient advocate at your facility — their job is to resolve exactly this.
• Veterans Service Officers at VSOs (DAV, VFW, American Legion, PVA) and at county veterans service offices. Free, experienced, and frequently effective at unsticking a stalled referral.
• Request the denial reason in writing, including which eligibility pathway was evaluated. Denials are sometimes based on a misreading of the access standard.
• Ask for reconsideration and escalate to the VISN level if needed.

If you are in crisis while you wait, do not wait. Veterans Crisis Line: dial 988 and press 1, or text 838255. Available 24/7 regardless of enrollment or discharge status.

Axis Mental Health and community care

We provide outpatient mental health and substance use treatment in Desert Hot Springs and telehealth across California — therapy, psychiatric medication management, dual-diagnosis care, and PTSD-informed treatment. Our First Responders Program serves veterans who moved into law enforcement, fire and EMS careers.

Call (855) 405-2733 and tell us you are a veteran with, or seeking, a community care authorization. We will tell you plainly what we can provide and whether we are the right fit for your authorization. If we are not, we will point you somewhere that is.

Frequently asked questions

Do I need a VA referral before I go?

For scheduled care, yes. Without authorization you risk being billed directly. The two exceptions are in-network urgent care, which needs no prior authorization, and emergencies — go to the nearest ER and notify VA as soon as you can.

How long does authorization take?

It varies by facility and by how straightforward the request is. Days in good cases, weeks in others. Following up by phone genuinely speeds it up, and a Veterans Service Officer can help if it stalls.

Can I keep my VA provider and add a community provider?

Often yes. Community care is generally episode- or service-specific rather than an all-or-nothing switch. Many veterans keep VA primary care while receiving mental health or substance use treatment in the community.

Will I have a copay?

Possibly, depending on your priority group and the type of care — the same copay structure that applies to VA care. Service-connected conditions are typically copay-free. Ask your VA community care office for specifics before you start.

What if my authorization runs out mid-treatment?

This is the most common failure point. Ask about renewal when you are roughly two-thirds through your authorized visits, and have your provider submit continued-care documentation early. Do not wait for the last visit.

Related pages

• The VA MISSION Act
• Alcoholism in Veterans
• Caregiver Support
• Co-Occurring Disorders
• Southern California Rehab Guide

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