The Elizabeth Dole Act: What Veterans Need to Know About Faster Access to Community Care

In early 2025, the 21st Century Veterans Healthcare and Benefits Improvement Act (“Elizabeth Dole Act”) went into effect. The Act brings significant changes to how veterans can access care outside the VA system. Among the most important updates is the removal of the requirement for a second review of a clinician’s decision to refer a veteran to community care (care outside the VA). In other words, the Act makes it, so veteran patients don’t have to wait for another doctor or administrator within the VA system to agree and “green light” a referral out to community care.

In theory, this should mean veterans can get the care they need more quickly. Our firm has seen far too many cases where a patient’s treatment gets jammed up, overlooked, and delayed because of issues related to this second layer of approval. Most patients don’t have time to waste when it comes to their medical care, and delays can make treatment more complicated, or even worse, ineffective. The passing of the Dole Act will be a helpful change if all the impacted facilities respond accordingly.

However, in some places, veterans are still being told they must wait for “approval” after their doctor has already referred them out. Given this lag in response from some facilities, it is important for veterans to know and understand the impact of the Dole Act in order to help themselves get the community care they need as quickly as they’re entitled to it.

What Changed Under the Elizabeth Dole Act?

Previously, when a VA clinician determined that a veteran should be referred to community care, that decision often had to go through a second review—sometimes by another doctor, sometimes by an administrator. This extra step could delay care significantly as veterans waited for the “green light” to see a community provider.

The Elizabeth Dole Act was designed to streamline this process. Now, once a VA clinician decides a veteran needs community care, that decision should stand. That means no more waiting for a second opinion or administrative approval. According to the VA’s own announcement, this change is meant to “make it easier for Veterans to use community care” and reduce unnecessary delays. (Source: VA Newsroom)

Why Are Some Veterans Still Waiting?

Despite the new law, reports from some areas suggest that veterans are still being told they need to wait for that second approval or “green light” after their doctor refers them out to community care. This can be confusing and frustrating, especially for those who need timely care.

There are a few possible reasons for this disconnect:

• Local Implementation Lag: Sometimes, it takes time for new federal policies to be fully implemented at the local level. Staff may not be fully trained on the new procedures, or old habits may persist.

• Administrative Processes: While the second clinical review is no longer required, there may still be administrative steps (such as verifying eligibility or coordinating with community providers) that can cause delays. However, these should not override the clinician’s referral.

• Communication Gaps: Veterans may not be receiving clear information about what to expect, leading to confusion about what “approval” actually means under the new rules.

What Options Do Veterans Have If They Are Told to Wait?

If you are a veteran whose VA clinician has referred you to community care, you should not have to wait for a second clinical review or approval. If you are told otherwise, consider the following steps:

1. Ask for Clarification: Ask the staff to explain the process and reference the recent changes under the Elizabeth Dole Act.

2. Request Written Information: Ask for any written policy or guidance that explains why you are being asked to wait.

3. Contact a Patient Advocate: Every VA facility has a patient advocate who can help resolve issues and ensure you receive the care you are entitled to.

The Elizabeth Dole Act was a major step forward in making it easier for veterans to access community care. While the law is clear that a second review is no longer required, implementation on the ground may lag behind. Veterans should be aware of their rights and advocate for timely access to care. If you or someone you know is experiencing delays, don’t hesitate to ask questions and seek help from VA patient advocates.