Independent New Hampshire Journalism · Northfield, NH

The VA Spent $1.44 Billion in New Hampshire in Fiscal 2025. Nearly Two of Every Five of Its Medical Dollars Paid for Care Outside the VA.

Federal figures put community care at 38.2 percent of the Department of Veterans Affairs’ medical spending in New Hampshire, the fourth-highest share among the 50 states, and above half in Coos County. The VA’s own model projects the state’s veteran population to fall from about 89,000 to about 49,000 by 2053.

The U.S. Department of Veterans Affairs spent $1.44 billion in New Hampshire in the federal fiscal year that ended Sept. 30, 2025, by the department’s own accounting. More than nine of every ten dollars went to two things. Disability compensation and pension payments to veterans came to $647.7 million, about 45 percent of the total. Medical care came to $678.0 million, about 47 percent. Of that medical spending, $419.2 million was for care at VA facilities, a category that also carries VA medical research, canteen and prosthetics spending, and $258.8 million was for “Medical-Community Care,” which the VA defines as health care services provided outside its own facilities, in private or community settings.

That split is the number that sets New Hampshire apart. Community care made up 38.2 percent of the VA’s medical spending in the state. Among the 50 states, only Alaska, Montana and North Dakota had a higher share. Guam, a territory without a full-service VA health facility, was at 58.1 percent. Across the whole report, every state, territory and line for spending abroad or with no known location counted together, the share was 28.7 percent.

Where the numbers come from

The figures are from the VA’s Geographic Distribution of VA Expenditures report for fiscal year 2025, known as GDX, prepared by the department’s National Center for Veterans Analysis and Statistics and dated September 2026. The report breaks VA spending down by state, county and congressional district. It sorts the money into direct benefits paid to veterans and their families, such as compensation, pension and survivor benefits, and what it calls indirect benefits, such as medical care, education benefits, home loan guaranty costs, construction and burial benefits.

For most programs, the report says, the county figures come from the VA offices that run them: the Veterans Health Administration’s Allocation Resource Center for medical care and the Veterans Benefits Administration for compensation, pension, education and loans. Construction spending, and the National Cemetery Administration’s share of memorial spending, are placed by the location of the facility where the work or service took place. The report does not spell out, for medical care, whether a dollar is counted where a veteran lives or where the care was given.

Why New Hampshire leans on community care

The VA’s eligibility page for community care lists the ways a veteran can qualify for care from a private provider in the VA’s network, paid for by the VA. One of them is living “in a state or territory that doesn’t have a full-service VA health facility.” The same page gives an example: “You live in Alaska, Hawaii, New Hampshire, Guam, American Samoa, the Northern Mariana Islands, or the U.S. Virgin Islands. We don’t have a full-service VA health facility in your state or territory.”

Other routes apply everywhere. A veteran can qualify when the VA cannot meet its access standards: a 30-minute average drive or a 20-day wait for primary care, mental health and extended outpatient care, and a 60-minute average drive or a 28-day wait for specialty care. A separate rule covers veterans in Alaska, Montana, North Dakota, South Dakota and Wyoming who qualified under an older 40-mile distance requirement as of June 6, 2018.

The five states with the highest community care shares in the fiscal 2025 report are Alaska, Montana, North Dakota, New Hampshire and Hawaii, in that order. Each of the five is either in a state with no full-service VA health facility (Alaska, Hawaii, New Hampshire) or among the states covered by the older 40-mile rule (Alaska, Montana, North Dakota). The report itself does not explain any state’s share, and the overlap is Granite State Report’s observation, not a finding by the VA.

The hospital question

New Hampshire’s congressional delegation has made the hospital question a standing issue. A May 15, 2025, press release from U.S. Rep. Chris Pappas said New Hampshire “is the only state in the contiguous 48 states to not have a dedicated, full-service VA hospital.” A Sept. 26, 2025, release from U.S. Sen. Jeanne Shaheen described the state as “one of only three states in the country that does not have a full-service VA hospital.” The two statements count differently, one the lower 48 and the other the whole country. The VA’s community care page, which names Alaska, Hawaii and New Hampshire among the places without a full-service VA health facility, is consistent with both.

A May 9, 2025, executive order signed by President Donald Trump directed the secretary of veterans affairs to order, within 30 days, “a feasibility study at the Manchester VA Medical Center” and, within 180 days, to submit “an action plan to expand services to support a full-service medical center in New Hampshire so that it is no longer the only State in the contiguous United States without such a center.”

In an April 23, 2026, letter to the White House Domestic Policy Council director and the VA secretary, Pappas, Shaheen and U.S. Sen. Maggie Hassan wrote that VA had confirmed in an April 15, 2026, briefing that the study and the action plan were complete and had gone to the White House. By the letter’s account, VA said the option chosen was the one in the fiscal 2027 presidential budget request, a “new VA-owned medical center providing comprehensive outpatient services in Manchester, New Hampshire,” and the White House had declined to share either document with Congress, calling them “pre-decisional” and “deliberative.” The letter asked that both be made public by April 28, 2026. Those are the delegation’s descriptions of what VA told it. The study and the plan themselves are not among the sources for this article.

County by county

Inside the state, the community care share runs from 21.6 percent in Sullivan County to 50.4 percent in Coos County, the only county where the VA spent more on community care than on care in its own facilities, $12.5 million against $12.3 million. Carroll was next at 49.9 percent, then Belknap at 46.7 and Strafford at 46.0. The two counties with the lowest shares, Sullivan and Grafton at 30.2 percent, sit along the Connecticut River on the Vermont line.

Hillsborough County drew the most VA money of any county, $408.8 million, followed by Rockingham at $279.1 million. Coos drew the least, $51.3 million. The only construction spending the report places in New Hampshire, $6.4 million, is in Hillsborough County, where the Manchester medical center stands.

Fewer veterans ahead

The VA’s population model, VetPop2023, estimated about 93,000 living veterans in New Hampshire on Sept. 30, 2023, and about 89,000 on Sept. 30, 2025. It projects about 79,000 in 2030 and about 49,000 in 2053, a drop of about 45 percent from 2025. The model projects the national veteran population to fall about 36 percent over the same years, from about 17.6 million to about 11.2 million.

The VA describes VetPop2023 as a model that starts from its own records on veterans through Sept. 30, 2023, blends in Census Bureau survey estimates for older veterans, then projects one year at a time by subtracting deaths, applying migration assumptions between states and adding people leaving the military. County figures are allocated from the state projections. The department says the tables should be reported to the nearest 1,000.

The model projects a decline in every county. By its unrounded figures, Coos County’s veteran population falls about 54 percent between 2025 and 2053 and Sullivan’s about 52 percent; Strafford’s falls the least, about 40 percent. About half of the state’s veterans in 2025, by the model’s estimate, were 65 or older. The number of women veterans changes little in the projection, about 9,000 in 2025 and about 8,000 in 2053, while the total shrinks, so women’s share rises from about 10 percent to about 17 percent.

What the numbers leave out

Spending per veteran is a rough yardstick, since some of the money goes to survivors and dependents rather than to veterans. With that caution, the fiscal 2025 total works out to roughly $16,000 for each of New Hampshire’s estimated veterans, against roughly $19,000 across the whole report. The report counts dollars, not appointments, so it does not show how long veterans waited, how far they drove or how the care turned out. And a high community care share can reflect what the VA does not offer close to home as much as what veterans choose. As published in October 2026, the fiscal 2025 report, dated September 2026, is the latest in the series, and VetPop2023 is the newest model posted on the VA’s veteran population page.

— Granite State Report

Fact check

Editor’s note. Spending figures are drawn from the U.S. Department of Veterans Affairs’ Geographic Distribution of VA Expenditures report for fiscal year 2025 and its description of methods. Veteran population figures are drawn from the VA’s VetPop2023 state and county tables and the department’s description of the model. Eligibility rules are drawn from the VA’s community care eligibility page. The executive order is quoted from the White House text; the delegation’s statements are quoted from its press releases and its April 23, 2026, letter. Shares, ranks, totals, percent changes and per-veteran figures are Granite State Report arithmetic from the VA’s figures.

Corrections: Granite State Report corrects verified errors promptly and runs a dated note at the top of the article identifying what changed and when. The corrections policy and the corrections register are public, and correction notes are never removed.