VA Health Care: Recommendations and Observations to Improve Community Care and Support for Caregivers Related to the Dole Act

What GAO Found

The Department of Veterans Affairs (VA) allows eligible veterans to receive health care from community providers through the Veterans Community Care Program. Since 2020, GAO has made several recommendations to improve access to the Veterans Community Care Program in areas also highlighted by the 2025 Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act (Dole Act). As of February 2026, VA has not fully implemented GAO’s recommendations. For example:

• Timely appointment scheduling. In 2020, GAO found that most Veterans Health Administration (VHA) facilities from the region included in its review did not have the recommended number of staff needed to manage community care referrals, creating potential risks to timely scheduling. GAO recommended that VHA assess community care staffing needs to identify and address any risks. VHA agreed with this recommendation and is working to enable its staffing tool to identify and report such risks, according to officials. GAO also recommended that VHA establish a wait time measure for community care appointments and align its performance metrics. VHA disagreed with this recommendation but has defined time frames for some steps. VHA has not fully implemented these recommendations. The Dole Act requires VA to take action on its staffing model and performance metrics to ensure timely care for veterans.
• Referral coordination and communication. In 2025, GAO reported that VHA facilities had mixed results in implementing the Referral Coordination Initiative, which aimed to improve referral coordination and streamline appointment scheduling. VHA had not documented key elements of the initiative in policy, which may contribute to inconsistences in implementation and limit staff and veterans’ understanding of community care options. GAO recommended that VHA include this initiative in its national policy. VHA concurred in principle with the recommendation, but has not yet implemented it. GAO also reported in 2025 that the Office of Integrated Veteran Care, which VHA created to improve coordination of community care, did not always clearly communicate information to its facilities. GAO recommended that VHA ensure this information is clearly communicated. VHA concurred with this recommendation but has not yet implemented it. The Dole Act also requires VA to review facilities’ processes for making such referrals.

GAO also has ongoing work on VHA’s Caregiver Support Program. Preliminary results show that VHA responded to challenges caregivers reported with accessing in-person support by implementing a virtual therapy program. VHA also established goals to assess the effectiveness of its outreach efforts. These include a goal to increase program enrollment by 15 percent each fiscal year, which it met in fiscal year 2025. However, VHA has not set quantitative targets and time frames for its other goals. Doing so would better position VHA to assess its efforts and make any needed adjustments. The Dole Act also includes provisions addressing caregivers’ access to and awareness of VHA’s Caregiver Support Program.

Why GAO Did This Study

The Dole Act authorized significant expansions of health care programs for veterans and support for their caregivers. These programs are administered by VHA.

An increasing number of veterans receive their care from providers outside of VHA facilities through the Veterans Community Care Program; in 2024, about 3.1 million veterans received such care. VHA also provides services and support to nearly 100,000 caregivers of veterans who suffered serious injuries in the line of duty through its Caregiver Support Program. Concerns have been raised about the mental health of veterans’ caregivers who often provide around the clock care that enables veterans to live at home and help with their recovery.

GAO has a large body of work related to aspects of the community care and caregiver programs, both of which were addressed in the Dole Act. This statement summarizes recommendations and related work on the Community Care program. It is based on three GAO reports issued from 2020 through 2025 (GAO-20-643, GAO-25-106678, and GAO-25-107212). This statement also includes preliminary results from GAO’s ongoing work examining VA’s efforts to provide mental health support to caregivers. To do this work, GAO reviewed VHA documents on its caregiver program and interviewed VHA officials, program staff, and participating caregivers at four selected VHA facilities.

For more information, contact Sharon M. Silas at silass@gao.gov.