The Veterans Community Care Program represents a significant shift in how the Department of Veterans Affairs (VA) provides healthcare to eligible veterans. Over the past decade, Congress has actively worked to broaden veterans’ access to healthcare services outside of traditional VA facilities, delivered by community health providers. The VA MISSION Act of 2018 was a pivotal piece of legislation in this evolution, formally establishing the current Veterans Community Care Program. This program’s growing utilization marks a major transformation in the VA healthcare system.
The Government Accountability Office (GAO) has been closely monitoring the Veterans Community Care Program, identifying key areas needing improvement. GAO’s oversight has resulted in 27 recommendations aimed at strengthening the program, particularly in two critical domains: appointment scheduling and wait times, and VA’s supervision of the contractors responsible for program implementation, which includes ensuring adequate provider networks. To date, the VA has implemented 9 of these recommendations and is actively working towards implementing others.
Challenges in Scheduling and Wait Times
A crucial aspect of healthcare access, as defined by the VA, is the timeframe veterans experience from referral to receiving care, whether at a Veterans Health Administration (VHA) facility or within the community care network.
In a June 2018 GAO report, it was recommended that the VA establish a clear community care scheduling process with defined timeframes for critical stages: referral processing, appointment scheduling, and the actual occurrence of appointments. While the VA agreed with this recommendation and successfully implemented the first two components—establishing timeframes for referral processing and appointment scheduling—it has yet to set standard timeframes for when appointments must take place. Consequently, this specific recommendation remains only partially implemented, highlighting an ongoing area for improvement.
Further scrutiny in a January 2025 GAO report focused on VHA’s Referral Coordination Initiative. This initiative was designed to enhance scheduling efficiency and improve the overall veteran experience with community care. However, GAO’s findings revealed inconsistencies in the initiative’s implementation, a point acknowledged by VHA officials. To address this, GAO recommended that VHA ensure comprehensive program direction is formally documented in national policy and guidance. This direction should encompass strategic goals, standards for consistent implementation across different locations, clearly defined roles and responsibilities, and robust oversight and accountability mechanisms. The VA has concurred in principle with this recommendation, signaling a commitment to improve the Referral Coordination Initiative.
Contract Oversight and Network Adequacy Concerns
The VHA’s Office of Integrated External Networks is central to the Veterans Community Care Program. This office is responsible for leading, developing, and overseeing the community care contracts and provider networks that veterans rely on.
A November 2022 GAO report brought to light the need for enhanced VA oversight and improved data collection regarding its community care network providers. The report made two recommendations focused on these areas, both of which have been implemented by the VA, demonstrating progress in this aspect of program management.
However, an August 2024 GAO report identified persistent weaknesses in the VA’s oversight of community care contracts. For instance, the office tasked with contract oversight had not developed a complete and well-defined set of guidelines to effectively conduct its oversight duties. Among other concerns, this lack of clear guidance raised questions about the thoroughness and consistency of contract management. In response to these findings, GAO issued three recommendations aimed at strengthening contract oversight. The VA has concurred with these recommendations and outlined planned actions to address the identified shortcomings, which GAO will continue to monitor during the recommendation follow-up process.
The Importance of Community Care for Veterans
The VHA manages one of the largest healthcare delivery systems in the United States, providing care to over 6 million veterans. While the majority of veterans still receive their healthcare within VHA-operated medical facilities, there has been a significant increase in the number utilizing community health care providers. According to VA data, this number has risen from approximately 1.1 million veterans in 2014 to around 2.8 million in 2023. This substantial growth underscores the increasing reliance on and importance of community care programs for veterans’ healthcare access.
This analysis, based on seven GAO reports issued between 2018 and 2025 (referenced as GAO-18-281, GAO-20-643, GAO-23-105290, GAO-23-105617, GAO-24-106410, GAO-24-106390, and GAO-25-106678), highlights the VA’s ongoing efforts to ensure veterans receive high-quality healthcare, particularly through community providers. It also underscores the crucial role of GAO oversight in identifying opportunities to further improve VA operations and the effectiveness of the Veterans Community Care Program. Continued focus on addressing the identified challenges in scheduling, wait times, and contract oversight is essential to optimize the program and ensure veterans receive timely and effective healthcare services within their communities.
