Under Dole Act, veterans and their referring clinicians can choose community care without any additional review when it’s in the veteran’s best medical interest.
The U.S. Department of Veterans Affairs has announced it made more than $36 billion in payments to local healthcare providers across the country in fiscal 2025 as part of the bipartisan VA MISSION Act.
President Trump signed the MISSION Act in 2018 after it passed Congress with widespread bipartisan support. The law created a benefit that lets eligible veterans choose care from authorized local, non-VA healthcare providers at VA expense. VA pays for that care under the Veterans Community Care Program, which is the fourth largest healthcare payer program in America and provides healthcare services supporting more than 8.62 million enrolled veterans.
With the enactment of the bipartisan Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act in 2025, Congress reaffirmed its commitment to veterans’ healthcare choice by requiring VA to ensure that veterans and their referring clinicians can choose community care without any additional review when it’s in the veteran’s best medical interest. Under current law, veterans can also choose community care in other circumstances, including if their average driving time or wait time exceeds certain thresholds or when they need a service that is not provided by VA.
While community care is an important option for many veterans, VA is also spending record amounts of funding on direct care — a record high $101 billion was spent on direct care in fiscal 2025, when VA completed a record high 82,083,918 direct care appointments, up 4.1 percent from fiscal 2024.
Federal healthcare payer programs — like the Veterans Community Care Program, Medicare, Medicaid and TRICARE — are critical to the operation of every healthcare system in the country and help ensure patients get the care they need. That is especially true in rural areas, where millions of America’s veterans live. Rural healthcare providers sometimes operate on margins of less than 1 percent, which means VA community care payments help ensure these providers remain open and able to care for veterans, their families and others in the community.
In fiscal 2025, the top ten states that benefited from VA community care were:
· Texas, $3.3 billion
· Florida, $2.8 billion
· California, $2.1 billion
· North Carolina, $1.5 billion
· Ohio, $1.3 billion
· Tennessee, $1.2 billion
· Pennsylvania, $1.1 billion
· Michigan, $1.0 billion
· Georgia, $1.0 billion
· Arizona, $1.0 billion
See the full list of states here.
“When it passed the MISSION Act and the Dole Act, Congress promised all eligible veterans the ability to choose the healthcare that’s best for them — whether at a VA facility or a community provider,” VA Secretary Doug Collins said. “VA Community Care is a vital benefit that ensures the health of both veterans and the local economies where they live.”
- Veterans Healthcare