The Community Care River: $14.7 Billion to $36 Billion in Seven Years

The MISSION Act of 2018 opened the floodgates: veterans could get care from private providers, billed to the VA. The river that followed is the biggest money movement in modern VA history — and the water every middleman in this section swims in. By the VA's own proud description, the Veterans Community Care Program is now "the fourth largest healthcare payer program in America."

The growth

Veterans receiving community care rose from about 1.1 million in 2014 to about 2.8 million in 2023. Spending followed: $21.3 billion in obligations by FY2022, $26.7 billion spent in FY2023, and — per the VA's own announcement — more than $36 billion in payments to local healthcare providers in FY2025 (Florida alone: $2.8 billion, second only to Texas). The program now supports more than 8.62 million enrolled veterans.

The oversight did not grow with it

GAO has made 27 recommendations on the Veterans Community Care Program. As of February 2025, the VA had implemented nine. VA health care has sat on GAO's High-Risk List since 2015. The documented consequences live throughout this section: the $910.7 million two administrators kept on dental claims inside this river; the $416.63 million in improper community-care payments in FY2024 alone; rate schedules accepted by mistake and billed for years.

A river this size, administered this loosely, does not need villains to lose money. It loses money by default — and the people positioned along its banks, skimming percentages the contracts forgot to forbid, are simply collecting what the current carries to them.

Sources: GAO-20-669 · GAO testimony GAO-25-108101 · VA Office of Public Affairs release (FY2025 payments). Part of the VA Fraud record.