GAO: Veterans Health Care: Opportunities to Improve Access to Care Through the Veterans Community Care Program

Why GAO Did This Study

VHA operates one of the largest health care delivery systems in the U.S. It provides health care to more than 6 million veterans. The majority of veterans receive care in VHA-operated medical facilities. However, the number of veterans receiving care from community health care providers has increased from about 1.1 million in 2014 to about 2.8 million in 2023, according to VA.

This statement focuses on VA’s efforts to ensure that veterans have access to high-quality health care, particularly through community providers. It also discusses opportunities GAO has identified to improve VA operations. This statement is based on seven GAO reports that were issued between 2018 and 2025. See GAO-18-281, GAO-20-643, GAO-23-105290, GAO-23-105617, GAO-24-106410, GAO-24-106390, and GAO-25-106678. This statement also includes updated information on the status of GAO’s recommendations made in those reports.

What GAO Found

In the last decade, Congress has taken steps to expand the ability of eligible veterans to receive care from community health care providers. In particular, the VA MISSION Act of 2018 established the current Veterans Community Care Program. The increased use of community care through this program is a major change for the Department of Veterans Affairs (VA).

GAO has identified challenges and made 27 recommendations related to the Veterans Community Care Program regarding (1) scheduling and wait times and (2) VA oversight of the contractors used to implement the program, including provider network adequacy. VA has implemented 9 of these recommendations and taken steps to implement others.

Scheduling and wait times. VA considers a key component of access to be the time it takes veterans to receive care at Veterans Health Administration (VHA) facilities or in the community.

• In a June 2018 report, GAO recommended that VA establish a community care scheduling process with time frames within which veterans’ (1) referrals must be processed, (2) appointments must be scheduled, and (3) appointments must occur. Although VA concurred with this recommendation and implemented the first two components, it has not established standard time frames within which appointments must occur. Thus, this recommendation has not been fully implemented.
• In January 2025, GAO found that VHA’s Referral Coordination Initiative—intended to improve scheduling timeliness and veterans’ experiences—needs improved program direction and guidance. VHA officials acknowledged that implementation of the initiative had been inconsistent. GAO recommended that VHA ensure program direction—specifically strategic goals, standards for consistent implementation, roles and responsibilities, and oversight and accountability—is documented in national policy and guidance. VA concurred in principle with this recommendation.

Contract oversight and network adequacy. VHA’s Office of Integrated External Networks leads, develops, and oversees community care contracts and networks for veterans.

• In a November 2022 report, GAO found that VA needed to strengthen its oversight and improve data on its community care network providers and made two recommendations accordingly. VA has implemented both of these recommendations.
• In an August 2024 report, GAO found weaknesses in VA’s oversight of the community care contracts. For example, the office responsible for contract oversight had not developed a clear and complete set of documents to guide oversight, among other concerns. GAO made three recommendations to address these findings. VA concurred with these recommendations and described planned actions to address them, which GAO will evaluate during the recommendation follow-up process.

Recommendations

• GAO has made 27 recommendations to VHA to address challenges related to aspects of the Veterans Community Care Program in the reports covered in this statement. VA has implemented 9 of these recommendations. VA has taken steps to address the remaining 17 but has not fully implemented them as of February 2025. GAO closed one recommendation as not implemented because it was no longer valid given changes in VA. Fully implementing all the recommendations would help ensure VHA can provide veterans timely access to care.

Access the report here.

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