Advocacy Continues for Better TRICARE Coverage of Autism Treatment: "Our Military Families Have Waited Too Long for a Permanent Solution to the Problems Accessing Behavioral Health Treatment under TRICARE," Said Rep. Larson after the House Vote. "It's Hard Enough Being on the Battlefield Away from Home to Have the Extra Burden of Worrying about Your Kids' Care"

Article excerpt

At the start of 2013, many military families raising kids with autism would have believed that, by now, they would finally be getting the medical care their kids deserve. Instead, a pilot treatment program that that was supposed to be up and running by the start of April by order of Congress has yet to be implemented. And a federal judge who last year ordered TRICARE to cover a critical treatment for autism for all military families reconsidered and partially reversed his decision.

But raising 23,500 kids with autism makes these military families particularly averse to setbacks. They have been back at work advocating for the insurance coverage that can make a difference in their children's lives. By the midpoint of the year, their efforts had already borne fruit--the U.S. House of Representatives approved a permanent fix for TRICARE to cover behavioral health treatment for all military kids with developmental disabilities including autism.


The issue involves Applied Behavior Analysis (ABA), a behavioral health treatment that for 30 years has been demonstrated to help mainstream many children with autism spectrum disorders into society. ABA has been endorsed by the American Academy of Pediatrics and the U.S. Surgeon General. ABA is the most commonly prescribed evidence-based treatment for autism spectrum disorders, yet many insurers still deny coverage for ABA based on the assertion that the therapy is "experimental" or educational and therefore should be left entirely to the schools.

ABA has proven particularly effective in the treatment of autism spectrum disorders, a medical condition brought on through no fault of the family and for which there is no known cause or cure. The nation's fastest growing developmental disability, autism affects a person's communication and social skills, and often causes repetitive patterns of behavior and a narrow range of interests. Its symptoms range from mild to severe.


Autism is particularly hard on military families. Because of the need for routine, children with autism find it difficult to cope with frequent redeployments and the disruption of familiar patterns. When one spouse is away serving abroad, the strain on the home spouse is particularly difficult when autism is part of the mix.

In recognition of these difficulties, the Department of Defense in 2008 agreed to cover ABA therapy though TRICARE's Enhanced Care Health Option (ECHO) program, but only for active duty personnel with annual benefits capped at $36,000. As a result, military members who retire from active duty--even if medically retired as a result of being wounded in action--discovered their child's autism benefits were cut off. Of the estimated 23,500 military kids with autism, only about 3,600 filed claims through ECHO.

Military families brought their case to Capitol Hill and others joined in a federal class action lawsuit to force TRICARE to extend ABA benefits to all military families and at medically prescribed levels. In late 2012, the House and the Senate approved sweeping changes in TRICARE's ABA coverage, but when the bill got to conference committee a one-year pilot program was created instead. President Obama signed the bill into law early this year which included a directive to TRICARE to start the pilot ABA program within 90 days, a deadline that fell, ironically, on April 2, World Autism Awareness Day.

But, TRICARE has yet to start the program or notify military families or ABA providers when it will begin or how it will work. As a result, military families redoubled their efforts with Congress to make TRICARE ABA coverage permanent for all military members. In early June, the U.S. House of Representatives approved an amendment to the new defense bill that would require the Pentagon to cover ABA care for all military families raising children with developmental disabilities, including autism, at medically prescribed levels



The bipartisan amendment to the National Defense Authorization Act (NDAA) was sponsored by Reps. …


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