Discrimination by uniform: an update on TRICARE and ABA therapy

Discrimination by uniform: an update on TRICARE and ABA therapyFor the first time—ever—Congress is purposely excluding certain members of the Uniformed Services from receiving some health care benefits because of their Service affiliation. Shocked? So are we.

When I speak about who our Association serves, I say that we work to improve the lives of active duty, National Guard and Reserve, retired, and surviving families of members of all seven Uniformed Services. Then I ask the trivia question: “What are the seven Uniformed Services?” In most cases, people easily name the Army, Navy, Marine Corps, Air Force, and Coast Guard, but they’re often stumped on the other two: the Commissioned Corps of the National Oceanic and Atmospheric Administration (NOAA) and the Public Health Service (PHS).

Members of all seven Uniformed Services take the same oath to support our Nation, are paid using the same pay tables, go where our leaders send them, earn the same retirement benefits, and receive the same TRICARE health care coverage. But this equality in benefits for their service that is granted by law is now threatened by the very Congress we ask to protect us.

A little background. Many military families with an autistic child, as well as some with other disabilities, have seen improvement when the child has access to Applied Behavior Analysis (ABA) therapy. Because TRICARE has provided ABA therapy under the ECHO Program, which is open to active duty families only and has an annual cap on costs, many military families have asked Congress to make it a covered TRICARE benefit to remove the cap and be available to retirees as well. They’ve encountered resistance for several reasons, most notably the cost.

The House’s version

In May, the House of Representatives added a provision to its version of the Fiscal Year 2013 National Defense Authorization Act (NDAA) that would make ABA therapy a TRICARE benefit for patients with an Autism Spectrum Disorder diagnosis. Normally, when a benefit is added to TRICARE, it applies to everyone that qualifies medically. In this case, however, the House decided it was acceptable to specifically exclude all  families of three Uniformed Services: the Coast Guard, NOAA, and PHS—a first.

The Senate’s version

On December 4, the Senate approved its version of the NDAA, which also contains a provision adding ABA therapy as a TRICARE benefit. At the request of our Association and others, the Senate provision opens up the therapy to anyone whose doctor believes would be helped. In response to our concerns about the House excluding three of the seven Uniformed Services from the benefit, the Senate included coverage for all active duty Coast Guard, NOAA, and PHS family members. But, it still specifically excludes retiree families of those Service branches.

What’s Needed

I don’t want to diminish the importance of this new TRICARE benefit. I’m glad Members of Congress have recognized the burden military families with a child needing ABA therapy face in finding and paying for the treatment. However, our Association is deeply concerned about the precedent this action by both Houses of Congress sets—and thinks that every military family should be as well.

Members of Congress have a chance to fix this inequity as they meet to create the final version of the NDAA. They must ensure eligibility for TRICARE benefits is determined by the medical needs of the patient, not the type of uniform their service member wears or wore.

How do you feel about these exclusions in the proposed NDAA?

Joyce RaezerPosted by Joyce Raezer, Executive Director at the
National Military Family Association


Add yours
  1. 1
    Patricia Halsey-Munroe

    Uniformed Services is different definition than Armed Services. All “Uniformed Services” serve this country equally!! Congress needs to study who is doing what on the front line!

    Thank you NMFA!!
    Colonel Trish Halsey-Munroe, USMCR (Retired) & also Retired Civilian Attorney for U.S. Coast Guard

  2. 3
    R Hatfield

    It appals me that Congress is Once Again trying to go back on their promise of medical for life after we or our loved ones have served. Retirees and continually treated as third class citizens and not only by Congress by our own services and service members as well. IRS quite disheartening.

  3. 5

    There are 20 million illegal aliens in this country who receive free health care and other benefits…not honorable military veterans….who does that make you feel?

  4. 6
    Cory Milan

    Well, Because they think that we retirees are older and if we have kids, they are already (or in most cases) out of the home on their own.. Well Guess what.. I retired as an E9 USCG and I am not in my 50’s, and as well, had children late in life. As may seem to be the case in today’s economy that families have children later in life just to make a good environment for their children before bringing them into this world. Though my family may not need these services, Why then exclude us retiree families? In actuality, the chances of them being needed are so small for our demographic, that it should not be a big concern for TRICARE. I’m sure there are other administrative and coverage benefits that can be streamlined for all, before isolating and cutting Benefits off for certain demographics.
    C.T Milan, HSCM, USCG Ret.

  5. 7
    Cory Milan

    Oh yes.. And it just came to me.. In light of recent event’s, though not associated with them supposedly, The political push is to expand mental health care. Leave it to TRICARE to cut them? And the Gov’t has hesitation. Hmm.. Just a thought here.
    C.T. Milan, HSCM, USCG Ret.

  6. 9
    Carla Mercer

    I am a veteran and husband retired. I have a son with autism and he has received private and tricare covered ABA. My comment here is based on our experience with unethical and fraudulent providers.

    I do not believe that we are being withheld from these benefits rather, the flock of money greedy providers taking advantage of the families and the system. If there were a more strict guideline set on providers, I believe there would be a better outcome.

    You do not see doctors acting and wining as some of these BCBAs. Of course they may have only needed post secondary education for a few years, where’s the professional standards? I understand both sides but more importantly, if the field of ABA providers start acting like professionals and not display behavior like they are money hungry, perhaps this benefit would be taken seriously.

    I have witnessed the poor quality of services in two different regions by at lease 5 providers. Having to file fraud complaints solely due to greed. Never mind the child is the only one harmed from poor quality services.

    So, Yes, I am a parent that wants Tricare to create stricter policies just so to weed out the bad apples. Then maybe they will take the remaining providers serious and do what needs to be done, and that is, to provide benefits to all beneficiaries ensuring that a high quality of standards and care is met.

Leave a Reply