WASHINGTON, D.C. — The Department of Veterans Affairs last Monday launched a sweeping two-track initiative aimed at reshaping how millions of veterans receive health care, announcing new community care contracts designed to expand choice while moving to dismantle layers of bureaucracy inside the Veterans Health Administration.
The VA released a request for proposals for next-generation community care contracts that will govern how veterans access non-VA medical providers over the coming decade. The program, which allows veterans to receive care outside VA facilities at government expense, now accounts for roughly 40 percent of all VA-provided health care.
Community care has existed in various forms since World War II, but it was formally codified in 2018 when President Donald Trump signed the bipartisan MISSION Act, guaranteeing veterans the right to seek outside care under defined conditions. Contracts signed that year with third-party health plans are set to expire in 2026, prompting the new solicitation.
Under the proposed contract framework, the VA will use an indefinite delivery, indefinite quantity structure that allows multiple national and regional health plans to compete for work. Agency officials say the approach will expand options for veterans, raise care standards by requiring adherence to industry-wide medical benchmarks, and give VA stronger real-time oversight through improved data and technology systems.
The contract design also allows VA to adjust regions, requirements, and vendors over time, replacing underperforming plans without disrupting veterans’ care.
“VA has learned a lot about community care over the years, and we are putting that knowledge to use to help veterans with the next generation of community care contracts,” VA Secretary Doug Collins said, adding that the changes are intended to improve both quality and choice.
At the same time, the department announced plans to reorganize the management structure of the Veterans Health Administration, the nation’s largest integrated health care system. The restructuring, expected to unfold over 18 to 24 months beginning in 2026, is intended to streamline decision-making, clarify roles, and shift authority closer to hospitals and clinics.
VA officials said Congress has been briefed on the plan, which responds to years of criticism from the Government Accountability Office and the VA’s Office of Inspector General. Those reviews have repeatedly cited overlapping responsibilities, unclear lines of authority, and excessive management layers that slowed operations and weakened oversight.
Under the new structure, VHA Central Office will focus on policy, financial management, oversight, and compliance. Regional networks and operations centers will be responsible for translating policy into performance and quality standards, while local VA health systems will gain clearer guidance and greater authority over day-to-day care delivery.
The department emphasized that the reorganization is not a reduction in force and is not expected to significantly change overall staffing levels. Operations at VA medical centers and outpatient clinics will continue without interruption.
“The current VHA leadership structure is riddled with redundancies that slow decision making, sow confusion, and create competing priorities,” Collins said. “Under a reorganized VHA, policymakers will set policy, regional leaders will implement it, and clinicians will focus on taking care of veterans.”
Together, the expanded community care contracts and internal restructuring represent one of the most significant shifts in VA health care governance in years, as the department seeks to balance broader access to private-sector care with tighter oversight and a leaner management structure focused squarely on veterans’ needs.
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