Access to Healthcare for Rural Veterans
A disproportionate share of veterans and veterans with service-related injuries live in rural America. According to the Veterans Health Administration - Office of Rural Health (VHA-ORH), of the 22 million veterans in the U.S., 5.3 million veterans, or 24%, live in rural America. 3.2 million of these rural vets are enrolled in the Veteran Affairs (VA) health care system, accounting for 35% of total enrollees. Approximately 2.8 million VA patients are affected by a service-related injury - 1,027,000, or 36%, of those patients come from rural areas.
Many veterans living in rural areas fail to get the help they need and are entitled to because of barriers to healthcare, with the primary barrier being the geographic distance to the nearest Veterans Health Administration facility. In addition, veterans may be unaware of the benefits, services, and facilities available to them, which can result in those veterans receiving more costly healthcare at a non-VA facility or no care at all for a variety of chronic and acute mental, social, and physical conditions. Some rural veterans face poverty, homelessness, and substance abuse which further exacerbate their health issues.
VA health facilities can address rural access issues by developing partnerships with area community health clinics, Rural Health Clinics (RHCs) and hospitals to deliver care via telemedicine, mobile VA clinics, and community based outpatient clinics. More and more, the VA also depends on nonprofit veteran service organizations to help veterans access healthcare and basic human services. The VA is addressing the issues affecting rural veterans with programs, such as the Veterans Choice Program which provides an option for rural veterans meeting certain criteria to receive non-VA healthcare rather than waiting for a VA appointment or traveling to a VA facility.
For additional information regarding other concerns faced by rural veterans, including health insurance, housing, job training, and funding for education see the following topic guides:
- Healthcare Access in Rural Communities
- Human Services to Support Rural Health
- Scholarships, Loans, and Loan Repayment for Rural Health Professions
Frequently Asked Questions
- What types of health programs are available to rural veterans?
- Who is eligible for VA health benefits?
- How can healthcare providers, counselors, social workers, and clergy help rural veterans who are in need of healthcare, behavioral health, or disability related services?
- What is the Veterans Choice Act and what does it mean for rural veterans and rural healthcare providers?
- What opportunities are there for rural healthcare facilities to collaborate with the VA?
- What are the special health concerns faced by rural veterans?
- Are there any VA health resources targeted specifically to the rural Native veteran?
- Are there grants or programs to assist veterans in rural areas with transportation to VA medical centers and other VA and non-VA facilities for medical care?
- What organizations provide assistance to rural veterans to help them maintain their health needs?
- What is the infrastructure within the federal government for addressing concerns regarding rural veterans’ health?
- What are some demographics that characterize veterans who live in rural areas?
What types of health programs are available to rural veterans?
The Department of Veterans Affairs provides a variety of health services to veterans meeting certain military requirements. Health services available for eligible veterans include:
- Primary and Specialty Care
- Dental Care
- Vision Care
- Mental Health Services and Coverage
- Assisted Living and Home Health Services
Who is eligible for VA health benefits?
There are a variety of eligibility requirements depending on the type of healthcare sought and the status of the service member. For details on eligibility requirements of active duty members, National Guard members, Reserve members, and retired veterans and affected families, see Veterans Eligibility: Health Benefits.
How can healthcare providers, counselors, social workers, and clergy help rural veterans who are in need of healthcare, behavioral health, or disability related services?
Healthcare providers and other professionals wanting to help rural veterans in need of healthcare and related services can encourage veterans to apply for veterans health benefits if they have not already done so. The Veterans Affairs Health Benefits website provides information about the health benefits and eligibility requirements. It also includes the forms for enrolling in VA care.
Healthcare providers can form a partnership with the Veterans Health Administration (VHA) and provide services to rural veterans as a non-VA facility if their facility meets the requirements of the Veterans Access, Choice and Accountability Act of 2014. The FAQ What opportunities are there for rural healthcare facilities to collaborate with the VA? provides more specific information on this topic.
Several resources are available from Veterans Affairs to help guide the professional who is involved in the healthcare of veterans.
- I am a Clinician, Researcher, or Trainee – this section of the VA website provides tools and training resources for clinical professionals
- Community Provider Toolkit – contains tools and resources for clinicians providing mental health services
- Military Culture: Core Competencies for Health Care Professionals – provides the education, tools, and resources to help healthcare professionals understand the military culture and modify their clinical practice to appropriately treat service members or veterans.
- Community Clergy Training to Support Rural Veterans Mental Health – sponsored by VHA-ORH. This program trains community clergy and chaplains in the skills necessary to support veterans and their families who are dealing with physical, mental, emotional, and spiritual concerns
- VA Facilities Locator & Directory – provides information on the closest VA healthcare facility to a specific location
- Non-VA Medical Care Program Office – provides additional information about non-VA medical care including emergency medical services, Indian Health Services/Tribal Health Program, and Patient-Centered Community Care (PC3)
- PSTD: National Center for PTSD – includes training materials and other resources for to aid in the assessment and treatment of veterans who may have PTSD
What is the Veterans Choice Act and what does it mean for rural veterans and rural healthcare providers?
On August 7, 2014 the Veterans Access, Choice and Accountability Act of 2014 was signed into law. It includes a variety of reforms to improve and expand access to quality healthcare for veterans. Most importantly, this law developed the Veterans Choice Program, which requires the VA to offer non-VA healthcare to eligible veterans who live more than 40 miles from the nearest VA facility and when wait times are longer than 30 days or when deemed necessary by their healthcare provider. The Veterans Choice program is a temporary program that will end when the allocated funding is used or by August 7, 2017.
What opportunities are there for rural healthcare facilities to collaborate with the VA?
With the passage of the Veterans Choice Act, there are three different ways a rural non-VA health facility can provide service to veterans in rural locations. Rural healthcare facilities can participate as:
- Community Based Outpatient Clinics (CBOCs) – contracted by the VA to provide primary care services to veterans
- Patient-Centered Community Care Networks (PC3) – offer contracts to healthcare networks that provide primary care, mental healthcare, preventive services, and specialty care
- Contract providers under the Veteran's Choice Program (VCP) – contracted with the VA through a third party administrator (TPA) – Health Net or TriWest – as a pre-authorized healthcare provider
For information about contracting with the VA, see The Non-VA Medical Care Program Fact Sheet for Interested Providers. This publication provides information about the Patient-Centered Community Care and Veterans Access, Choice, & Accountability Act programs and contact information for Health Net and TriWest. In addition, the National Association of Community Health Centers’ publication, Veterans Access, Choice and Accountability Act: What Health Centers Need to Know, provides information on how health centers can participate in the programs resulting from the Veterans Choice Act.
What are the special health concerns faced by rural veterans?
The health issues faced by rural veterans may be different from those of the general rural population due to disabilities and adverse health effects caused by their period of service. The VA Benefits Report, 2013, lists the following conditions as prevalent service-connected disabilities affecting veterans:
- Tinnitus and hearing loss
- Post-traumatic stress disorder (PTSD)
- Musculoskeletal issues
- Scars, general
- Diabetes mellitus
- Paralysis of the sciatic nerve
According to this 2011 presentation, the top 5 diagnoses for rural veterans in outpatient settings include hypertension, diabetes mellitus, hyperlipidemia, PTSD and depressive disorder. The presentation also states:
“Rural veterans report lower health‐related quality of life scores and they experience a higher prevalence of physical illness than their urban counterparts.”
Service-related and other health issues experienced by rural veterans can be exacerbated by the lack of specialty care in rural areas, as well as other conditions such as poverty, homelessness, and substance abuse.
Are there any VA health resources targeted specifically to the rural Native veteran?
Several programs have been developed by the VA that support culturally competent rural Native veteran healthcare. These programs include:
- Telemental Health Clinics – developed to provide services to Native veterans who live in rural and remote areas and who need mental healthcare to treat conditions including Post Traumatic Stress Disorder (PTSD)
- Tribal Veterans Representatives (TVR) – act as a liaison between veterans, the VA, and other organizations to help Native veterans access the necessary information and complete the process for healthcare services and other veteran’s benefits
- Native Veteran Services Directory – provides information, including contact information, regarding programs and services available to Native veterans
Are there grants or programs to assist veterans in rural areas with transportation to VA medical centers and other VA and non-VA facilities for medical care?
The U.S. Department of Veterans Affairs program Grants for Transportation of Veterans in Highly Rural Areas awards grants to veterans service organizations that use innovative approaches to assist veterans in rural areas with transportation to VA medical centers and other VA and non-VA facilities for medical care. A list of grantees providing transportation options to Veterans living in eligible rural counties is available from the Highly Rural Transportation Grants website. For additional programs that may assist veterans in accessing medical care, see the funding section of this topic guide.
Also, the Disabled American Veterans (DAV) Hospital Service Coordinator Directory provides a state-by-state list of Hospital Service Coordinators (HSCs), their affiliated VA Medical Centers, and contact information. HSCs manage DAV transportation programs for veterans needing medical care.
What organizations provide assistance to rural veterans to help them maintain their health needs?
- Veterans Health Administration – Office of Rural Health (VHA-ORH) – promotes strategies that will increase the healthcare opportunities for rural veterans including the use of technology and the availability of additional healthcare access
- South Central Mental Illness Research, Education and Clinical Center (MIRECC) – supports equal access and quality mental healthcare for veterans in rural and underserved areas
Several non-VA organizations provide assistance to rural veterans to help them maintain their health needs. Some of the more common organizations that are accessible in rural areas include:
- American Legion – provides assistance, outreach, and support for veterans and their families with VA claims and healthcare benefits
- Disabled American Veterans (DAV) – assists disabled veterans and their families when applying for benefits and services through the VA and other federal agencies
- National Coalition for Homeless Veterans (NCHV) – offers technical assistance and resources for a national network of community-based service providers, including local, state and federal agencies that provide housing, health services, food and job training for homeless veterans
The organizations section of this topic guide provides an annotated list of non-VA and VA organizations that provide assistance to veterans.
What is the infrastructure within the federal government for addressing concerns regarding rural veterans’ health?
The Veterans Rural Health Advisory Committee (VRHAC) is a panel of 15 members who advise the Secretary of Veterans Affairs on healthcare issues affecting veterans in rural areas. They examine ways to enhance Department of Veterans Affairs healthcare services for veterans in rural areas by evaluating current programs and identifying barriers to healthcare. For more information, see the VRHAC page on the VHA Office of Rural Health website.
What are some demographics that characterize veterans who live in rural areas?
According to the 2010-2014 American Community Survey 5-Year Estimates rural veterans are estimated to total 4,971,606 individuals or 24% of the entire veteran population. Other demographics include:
|Period of Service||% of Rural Veterans|
|Gulf War (9/2001 or later)||9.3%|
|Gulf War (8/1990 to 8/2001)||14.9%|
|World War II||6%|
|Sex||% of Rural Veterans|
|Race and Hispanic/Latino Origin||% of Rural Veterans|
|Black or African American||4.7%|
|American Indian/Alaska Native||1.1%|
|Native Hawaiian and Other Pacific Islander||.1%|
|Hispanic or Latino||2.3%|
|Below Poverty in the Past 12 Months||6.9%|
|Disability Status with Any Disability||30%|
Additional facts about rural veterans can be found in Rural Veterans at a Glance, a publication of the USDA’s Economic Research Service, including:
- Nearly half of rural veterans are 65 years of age or older
- Nearly 11 percent of rural residents are veterans
- The number of rural veterans declined from 6.6 million in 1992 to 3.9 million in 2011