Can Priority Group 5 veterans access community care or private inpatient rehab through VA referrals for non-service-connected needs?
Executive summary
Yes—Veterans in Priority Group 5 can get VA-covered care outside VA facilities when the VA authorizes community care, and VA operates inpatient and residential rehab programs that accept referrals; however Group 5 status does not automatically change eligibility rules, copayment responsibilities, or the clinical criteria VA uses to approve community or inpatient rehab referrals (see VA on community care eligibility and referral process [1] [2] and VA rehab programs and inpatient rehab authorization [3] [4]). Sources also show the VA may coordinate payment with other insurers for non‑service‑connected care and that private inpatient rehabs may be used with VA referrals or other insurance when VA care is unavailable [5] [6].
1. Who is in Priority Group 5 and what that means for access
Priority Group 5 generally contains Veterans without compensable service‑connected disabilities who meet low‑income or pension criteria; being placed in Group 5 affects copay rules and enrollment priority but does not by itself determine whether a specific community or inpatient referral will be authorized—the VA’s priority group assignment is separate from the clinical eligibility review for community care or inpatient rehab referrals (VA priority group description [7]; VA enrollment/priority context [8]).
2. VA community care: referrals, approvals and how they work
VA’s community care program covers care outside VA when a Veteran meets eligibility and the VA approves a referral; before a Veteran can schedule with a non‑VA community provider the VA must prepare and authorize a referral and will confirm eligibility [2]. The VA’s Community Care teams use systems such as HealthShare Referral Manager (HSRM) to process inpatient and outpatient authorizations; an inpatient admission request must be received and confirmed by the VA facility community care team before services are covered [9].
3. Inpatient and residential rehab options the VA provides
VA runs both residential/inpatient rehab programs (including Comprehensive Integrated Inpatient Rehabilitation Programs and other CIIRP/residential programs) and operates roughly 250 residential programs with capacity for thousands of Veterans; Veterans may apply directly or obtain referrals from VA providers or other programs for admission [3] [4] [10] [11]. These VA inpatient programs treat conditions from stroke and amputation to mental‑health and substance use disorders and accept Veterans who meet clinical admission criteria, regardless of priority group, provided they are eligible for VA medical center care [10] [11].
4. Can Group 5 Veterans get private inpatient rehab through VA authorization?
Available sources indicate the VA can authorize community care (including inpatient rehab) when VA cannot provide the needed care, and Veterans can receive inpatient rehab through the Community Care Network (CCN) if authorized; this applies to Veterans who are enrolled and meet the VA’s eligibility/clinical criteria—not because they are in Priority Group 5 specifically [1] [12]. VA and third‑party sites note that non‑VA rehabs participating in the Community Care Network work with VA referrals to treat Veterans closer to home [5] [12].
5. Money matters: copays, other insurance and billing implications
Priority Group 5 Veterans generally face copayments for medications and some services that higher‑priority groups may not, and copay rules vary with the type of service and disability status; community care copays and billing follow VA policies and may be coordinated with other insurance (for non‑service‑connected care the VA may bill Medicare or private insurance depending on circumstances) [13] [5]. Veteran guidance sites and VA literature stress tracking authorization letters and that services not included in the authorization won’t be covered [2] [9].
6. Practical steps and the VA’s gatekeepers
If you’re a Group 5 Veteran seeking private or community inpatient rehab, first enroll and see a VA provider, request a referral, and ask your VA community care team about CCN options and whether the program or facility you want participates; the VA will review eligibility and prepare an authorization, and you should confirm which services and copays are covered in writing [2] [9] [12]. For substance‑use care, VA guidance shows Veterans can get referrals through primary care or mental‑health teams and that inpatient care may be authorized via Community Care if clinically appropriate [14] [12].
7. Conflicting claims and reporting limits
Some secondary outlets and guides emphasize that Group 5 Veterans “can receive all healthcare services” or portray access as broadly open [15] [16] [17], while official VA pages make clear approvals depend on specific eligibility rules and referral authorizations [1] [2]. Available sources do not mention any automatic entitlement for Group 5 Veterans to private inpatient rehab without the standard referral/authorization and copayment considerations—authorization depends on VA clinical criteria and community care eligibility as described above (not found in current reporting).
Sources cited: VA priority rules and copay/benefits [7] [13] [8], community care eligibility and referral process [1] [2] [9], VA inpatient/residential rehab programs and referral pathways [4] [3] [10] [11], community/private rehab coordination and insurance billing [5] [6] [12].