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VA Plans Health Care Reorganization Starting in 2026
Medical centers and clinics will not see staff cuts under new structure, veterans department says
AARP (Jim West/UCG/Universal Images Group via Getty Images)
The Department of Veterans Affairs (VA) announced on Dec. 15 plans to launch a major restructuring of the Veterans Health Administration (VHA) but said the changes are aimed at reducing red tape and will not affect staffing at VA clinics and medical centers.
Details of the plan will be announced in early 2026 and implemented over an 18- to 24-month period, the VA said. The department cited independent reviews dating back nearly a decade, which it said found the VHA to be “rife with middle managers who have overlapping responsibilities,” thereby slowing decision-making and the delivery of care.
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Overall staffing levels across the VHA are expected to remain largely the same even after the changes are implemented, the VA said. The reorganization is intended to cut red tape, improve efficiency and strengthen care delivery without reducing staff.
While organizational details will be released when the plan is formally announced in early 2026, the effort is shaping up as one of the biggest changes in the VA’s health care system in years, affecting how policy is set, how operations are run and how care is given — both inside VA facilities and through private providers in the community. The shift could transform how millions of veterans receive care nationwide.
Under the new structure, VHA’s Central Office would be responsible for setting policy goals and overseeing finances and compliance. Operations Centers and Veterans Integrated Service Networks (VISNs) would then take direction from the Central Office, developing operational, quality and performance standards to guide over 1,300 VA medical facilities nationwide.
Currently, oversight is shared across three central offices that the Government Accountability Office said have been repeatedly reorganized — most recently in 2024 — to curb fragmentation, overlap and duplication. Meanwhile, the VA’s Office of Inspector General has repeatedly found inconsistent VISN practices that weaken accountability.
"Under a reorganized VHA, policymakers will set policy, regional leaders will focus on implementing those policies, and clinical leaders will focus on what they do best: taking great care of veterans,” VA Secretary Doug Collins said in a statement.
Changes to community care
The VA also announced plans to expand partnerships with private health care companies, giving veterans greater options to see doctors in their own communities as long as providers meet VA care standards. Currently, about 40 percent of all VA care is provided through community care, according to the department. The new plans suggest the VA is preparing to send more veterans to non-VA providers while continuing to cover the cost of that care.
The push toward expanded community care is also driven by expiring contracts. Many of the health plans currently managing VA community care are set to end in 2026, prompting the department to seek new agreements aimed at improving choice, quality and oversight.
VA officials say the new contracts would give veterans access to a broader range of doctors while allowing the department to track care more closely and replace providers that fail to meet standards, without disrupting ongoing treatment.
Veterans are eligible for appointments with non-VA providers if:
- The care is in the veteran’s best medical interest.
- The necessary care isn’t easily available at a VA facility.
- The veteran lives in a state or U.S. territory without a full-service VA facility.
- The VA can’t meet designated wait time or drive-time standards
- The VA care fails to meet quality standards.
- The veteran qualifies under distance rules from the former Veterans Choice Program.
Before the announcement, VA wait-time standards were 20 days for primary care, mental health and noninstitutional extended care and 28 days for specialty care. The distance standards are a 30-minute drive for primary or mental health care and a 60-minute drive for specialty care.
VA clinicians still handle referrals, authorizations and medical record coordination, even when your care shifts to a civilian provider. If you’ve used community care before, the process should move faster now: In May 2025, the VA removed the secondary review step, so once you and your clinician agree on a referral, it no longer needs another VA doctor’s sign-off.
For many specialties common among older veterans — including cardiology; orthopedics; oncology/hematology; mental health; sleep medicine; pain management; eye care; ear, nose and throat care (ENT); and others — community care authorizations can now last 12 months without reapproval, reducing disruptions during transitions.
30 services covered by the one-year authorizations
The following types of care are eligible for streamlined, one-year community care approvals:
- Addiction medicine (outpatient)
- Addiction psychiatry (outpatient)
- Cardiology
- Dermatology
- Endocrinology
- ENT (otolaryngology)
- Eye care exams
- Family and couples psychotherapy (outpatient)
- Gastroenterology
- Hematology and oncology
- Mental health (outpatient)
- Nephrology
- Neurology
- Neuro-0phthalmology
- Nutrition services
- Oculoplastics
- Optometry (routine)
- Orthopedic (general)
- Orthopedic (hand)
- Orthopedic (spine)
- Pain management
- Physical medicine and rehabilitation (physiatry)
- Podiatry
- Podiatry (DS)
- Pulmonary
- Rheumatology
- Sleep medicine
- Urology
- Urogynecology
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