VA to Freeze New Community Care Enrollments on Jan. 26 Amid $1.17 Billion Shortfall

The Enrollment Freeze

The Department of Veterans Affairs will stop enrolling veterans in its Community Care program for new specialty appointments beginning Jan. 26, two VA officials told The Alamo Post. The freeze, which will last through at least March 15, is intended to slow spending after the program burned through $1.17 billion more than Congress appropriated for the current fiscal year, the officials said. The VA plans to notify congressional committees on Jan. 21 that new authorizations for cardiology, orthopedics, neurology, oncology, and mental health care will be paused unless the care is deemed clinically urgent, according to a draft notification letter reviewed by The Alamo Post.

The Community Care program allows veterans to receive treatment from private providers when VA facilities cannot schedule care within 30 days or when a veteran lives more than 40 miles from a VA clinic. About 1.8 million veterans used the program in fiscal 2025, according to VA data. The officials said the pause would affect roughly 180,000 scheduled or pending appointments during the 48-day freeze, including 63,000 authorizations that are already backlogged. The freeze does not apply to primary care, emergency services, or previously approved referrals, the officials said.

A representative of a major veterans service organization said the group learned of the freeze during a Jan. 17 briefing with Veterans Health Administration leaders. The representative, who asked not to be identified because the briefing was private, said the organization warned that veterans waiting for joint replacements, cardiac stents, and cancer evaluations would face severe hardship. The representative said VHA officials responded that the department would maintain urgent and emergent care but that routine referrals would be deferred.

The VA also plans to suspend outreach to veterans who had been scheduled for Community Care orientation calls between Jan. 26 and March 15, the officials said. Those calls cover roughly 12,000 veterans in the first two weeks of the freeze, according to an internal VHA spreadsheet dated Jan. 18.

How the Shortfall Grew

The $1.17 billion gap emerged because demand for outsourced mental health and cancer treatment exceeded projections by 22 percent, one of the VA officials said. The official, who works in the Veterans Health Administration, said program spending also rose after the VA expanded eligibility for emergency care in August 2025 and after two contractors, TriWest Healthcare Alliance and Optum Serve, raised per-visit rates on Jan. 1 under a renegotiated agreement. The rates for certain specialty visits jumped by 14 percent, the official said.

TriWest holds a $12.4 billion contract to administer Community Care in the western United States, and Optum Serve holds an $8.9 billion contract for the eastern half, according to procurement records. The second VA official said the department requested a supplemental appropriation of $890 million in November but that the Office of Management and Budget held the request because of broader deficit targets. The VA then tried to cover the gap by delaying payments to TriWest and Optum, but both contractors issued default notices on Jan. 12, the official said. The default notices triggered the freeze, which VA leaders approved during a 9 a.m. meeting at VA central office on Jan. 15, the official said.

The same official said the VA has already deferred $340 million in owed payments to TriWest and $290 million to Optum Serve since mid-December. Those deferrals have strained the contractors' ability to pay private clinicians, and several specialty clinics in Phoenix, Tampa, and Atlanta have stopped accepting new Community Care patients, the official said.

Congressional and Family Fallout

The House Veterans' Affairs Committee has scheduled a hearing for Jan. 28 to examine the shortfall, according to a congressional aide. The aide said committee chairman Rep. Mike Bost is expected to call VA Secretary Doug Collins and Veterans Health Administration Under Secretary Shereef Elnahal to testify. Senate Veterans' Affairs Committee staff plan to hold a closed briefing on Jan. 29, the aide said. A draft hearing memo names the freeze as the first item on the agenda.

A military spouse advocate who works with families at Fort Bragg, North Carolina, said the freeze would force many veterans to drive more than 100 miles to VA hospitals in Durham or Fayetteville because local Community Care referrals will be denied. The advocate, who spoke on condition of anonymity, said spouses had already begun rescheduling childcare and work shifts to accommodate the longer trips. The advocate estimated that 4,200 families in the Bragg area alone rely on Community Care for routine specialty visits.

The VA officials said the department hopes to lift the freeze on March 15 if Congress approves a reprogramming request that would shift $640 million from VA construction accounts and $530 million from information technology projects into Community Care. The officials said the request would be sent to Capitol Hill on Jan. 22, one day after the notification letter. TriWest and Optum Serve did not respond to requests for comment.