Using Your VA Benefits at Warriors Heart
WARRIORS HEART IS AN APPROVED VA COMMUNITY CARE PROVIDER
If you’re a veteran struggling with addiction, PTSD, and/or co-occurring disorders, you have the right to choose community care when the VA cannot provide timely treatment. Warriors Heart has active contracts with TriWest and Optum, which means all VA regions can refer eligible veterans to our program.
Understanding VA Community Care
The VA MISSION Act of 2018 allows VA to authorize care from a community provider when VA cannot provide that care itself within its access and quality standards. VA determines eligibility and issues the authorization.
You May Qualify for VA Community Care If
VA requires that you be enrolled in or eligible for VA health care and that you receive approval from your VA health care team before obtaining care from a community provider, except in certain urgent or emergency situations.
Per VA’s community care eligibility requirements.
You must meet at least one of the following eligibility requirements:
- You need a service VA does not provide at any VA health facility.
- You live in a state or territory that does not have a full-service VA health facility.
- You and your VA provider agree that getting care from an in-network community provider is in your best medical interest
- VA cannot provide the service you need in a way that meets VA’s quality standards.
- You qualified under the 40-mile distance requirement as of June 6, 2018, and you live in Alaska, Montana, North Dakota, South Dakota, Wyoming, or another location that would still make you eligible.
- VA cannot provide the care you need within VA’s standards for drive and wait times.
For primary care, mental health, and extended outpatient care, the standards are a 30-minute average drive time or a 20-day appointment wait. For specialty care, the standards are a 60-minute average drive time or a 28-day appointment wait. VA calculates average drive time using geomapping software rather than straight-line distance.
VA applies these requirements and makes the eligibility decision. Warriors Heart does not.
If VA Does Not Approve Your Community Care Request
Meeting a Community Care eligibility criterion does not by itself authorize treatment. VA must determine eligibility and generally issue the required referral or authorization before care begins.
A decision not to authorize community care is often a clinical judgment that VA can meet your needs directly, in many cases sooner than a community placement could be arranged. Before pursuing an appeal, ask your care team about VA residential options and about the regional screening process for placement. If you disagree with the decision, you may take the following steps.
A decision not to authorize community care is often a clinical judgment that VA can meet your needs directly, in many cases sooner than a community placement could be arranged. Before pursuing an appeal, ask your care team about VA residential options and about the regional screening process for placement. If you disagree with the decision, you may take the following steps.
- Request the decision in writing
Ask VA to document the decision, the reason for it, and the eligibility criteria applied. Keep a copy for your records. - Contact the VA Patient Advocate
Contact the Patient Advocate at your VA medical facility and ask for help resolving the referral issue. If the issue cannot be resolved informally, ask how to submit a written Clinical Appeal. - Submit a written Clinical Appeal
Identify the decision you disagree with, explain why you believe it should be reconsidered, and include any relevant medical records or supporting evidence. A community-care decision based on a medical determination may be reviewed through the VHA Clinical Appeals process. - Request VISN-level review
If you disagree with the written decision from the facility’s chief medical officer or designee, you may submit a second written appeal to the Patient Advocate for your Veterans Integrated Service Network. - Request outside assistance
You may contact an accredited Veterans Service Organization or your congressional representative’s constituent-services office for assistance. Congressional involvement does not replace VA’s review process or guarantee approval. - Contact Warriors Heart
We can explain our treatment program and verify a referral or authorization after VA issues it. Warriors Heart cannot determine VA eligibility, issue an authorization, influence VA’s decision, or guarantee approval.
Do not begin non-emergency treatment without confirming that VA has issued any required referral or authorization.
Sources: VA Community Care eligibility requirements and VHA Clinical Appeals guidance. Reviewed September 30, 2026.
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