EFMP Summary

Military Children with Disabilities Summary

2015 Medicaid-EFMP-ECHO Report Highlights

  • 64% are satisfied or very satisfied with EFMP
  • 37% of military families with a special needs had heard of the ECHO program.
  • 72% of military families whose child was enrolled in TRICARE ECHO were satisfied or very satisfied
  • 7% of military families with a special needs child reported they had heard of Medicaid HCBS waivers (4% for single parent households)
  • 1% respondents in military families whose child with special needs is currently/previously enrolled in Medicaid or who is currently/previously enrolled in Medicaid HCBS waiver reported they accepted an unaccompanied tour or had gone to a new duty station without their family so that their child with special needs would not lose their Medicaid benefits.
  • 6% were enrolled in a Patient Centered Medical Home (PCMH)
  • 26% of military families with a special needs child reported their child had a medical case manager or care coordinator

Nov 2011 National Council on Disability EFMP Report

“NCD findings indicate that EFMs and their Families face barriers that span the domains of health care, education, and long-term supports and services.

Key findings include: For Caregivers, navigating the health, education, long-term services systems, and obtaining and maintaining disability-related services require relentless hard work—a process they have to start over every time the Family moves. For some—particularly young parents, Families with more than one EFM, Families with a dependent with significant disabilities, parents who are themselves EFMs, and Families with a deployed sponsor—it can be an overwhelming prospect and can be so time-consuming that it becomes impossible for the spouse of an active-duty Marine to work outside the home.

  • Many Families lamented the lack of qualified health care specialists near their installations, and they struggle to obtain timely referrals and appointments and make long trips to medical specialists.
  • For Family Members in need of special education services, having to make frequent moves to a new school system results in substantial gaps in critical education and therapeutic services.
  • The lack of Medicaid portability across states is a significant barrier to obtaining necessary long-term supports and services for Families with EFM dependents. Each time the Family moves, they have to start over on a Medicaid waiver waiting list and often do not live in one place long enough to qualify. Tricare does not cover the same services provided under a Medicaid waiver.
  • Many families are dependent on the disability-related services typically covered by ECHO, a Tricare supplemental insurance, and they worry about how they will pay for these services when they retire and ECHO is no longer available to them.”

Sep 2014 TRICARE for Kids Coalition Response to July 2014 DoD Report


Short-term Goals

There are many steps that can be taken to address specific shortfalls, gaps and need for more clarification and collaboration acknowledged in the Report, including:

  • Align with preventive benefits available through the Patient Protection and Affordable Care Act (ACA), Bright Futures and Medicaid’s Early and Period Screening, Diagnostic and Treatment (EPSDT).
  • Align medical necessity definition for purchased care sector with AAP recommendation and broader definition allowed in the direct care system to ensure a consistent benefit and care.
  • Create a pediatric physician advisory group with internal and external practitioners that meets on a regular basis to provide pediatric specific perspective on policy and practices.
  • Establish an Advisory Panel on Community Support for Military Families with Special Needs as required by law.
  • Amend the inpatient only list TRICARE adopted from Medicare for pediatrics.
  • Several reimbursement areas cited in the Report could be addressed right away as an indication of good faith and a pathway toward streamlined processes. These could be implemented in conjunction with a pediatric payment advisory group.
  • Adjust definitions and provider categories as necessary to cover medical nutrition for children with complex nutritional needs.
  • Implement internal ECHO reforms and increase flexibility of ECHO benefit to ensure that it aligns with the Centers for Medicare & Medicaid Services (CMS) standards for community based supports and provides improved access and continuity of care to families.
  • Pediatric appropriate regulation of compounded medication coverage.
  • Convene data stakeholders advisory group to assist with metrics, appropriate comparisons, etc. for pediatrics including complex care and care coordination and management.
  • Immediately adopt mental and behavioral health standards more commonplace in pediatric care systems such as wrap around care, intensive outpatient programs, family centered care, community based care and uniform access to specialty care.
  • Remove artificial barriers to residential treatment center certifications.
  • Particularly with regards to EFMP families, compile recommendations from the many recent reports and studies and create a checklist of action items and issue areas to address. Tackle in collaboration with internal and external stakeholders.

…It is imperative that the DoD refrains from reinventing the wheel in order to address each of these areas in the Report. While some of the issues are unique to the DoD, such as the interaction of EFMP, ECHO and other support programs run by the military branches, and TRICARE and other programs run by DHA, many of the issue areas are those in which civilian organizations have expertise, interest and a commitment to serving military families. Public-private partnerships are critical to addressing the issues and findings in this Report, and TFK Coalition partners stand ready to assist, consistent with the Joint Chiefs of Staff White Paper on Expanding Public Private Partnerships.”

Senate Report 114-49 to accompany S.1376 (2016 NDAA), Page 156-157 Report

“…Section 735 of the National Defense Authorization Act for Fiscal Year 2013 (Public Law 112–239) required the Secretary of Defense to conduct a comprehensive review and analysis of health care provided to dependent children of members of the Armed Forces. The Department of Defense submitted the report in July 2014. Although the report concluded that the military health system meets the health care needs of children, including children with special health care needs, it acknowledged significant gaps and deficiencies in data collection, data utilization, and analysis.

The report deeply concerns the committee because data gaps and deficiencies in this area fail to substantiate the conclusion that the military health system meets the health care needs of children, especially those children with special needs.”

Blue Star Family EFMP Recommendations

  • The DoD can track and report the prevalence and profile of military family members with special needs across all of the military branches.
  • The DoD can ensure TRICARE benefits include medical care available under the AAP Bright Futures guidelines, Medicaid EPSDT programs, and the ACA to ensure beneficiaries have access to age and developmentally appropriate health care consistent with services available through the civilian market place and other government health care programs.
  • The DoD can improve reporting to TRICARE regarding the availability of specialty care providers to include the providers’ ability to accept new TRICARE patients.
  • TRICARE should allow access to EFMP staff and EFM family members to the availability of specialty care providers, particularly when considering PCS, and streamline referral and approval processes for specialty care to address high demand and long wait lists.
  • TRICARE can clarify the definition of a child with special needs to be consistent with the definition described by the National Institutes of Child Health and Human Development so that all children with special needs can be identified within the MHS and to support the comparison of evaluation and service satisfaction metrics.
  • At the state level, DoD can support coordination between military health administrators and Medicaid administrators to address issues such as long wait lists, complexity of waivers, and state to state barriers for enrollment.
  • The DoD can increase communication, dissemination, and outreach efforts to families who may be eligible for TRICARE Extended Care Health Option (ECHO)
  • The DoD can provide a regular evaluation of ongoing efforts to ensure all beneficiaries with 1developmental disabilities, including autism, have affordable and timely access to recommended behavior intervention services, including ABA.
  • The DoD, nonprofits, and community-based providers can work to educate military families regarding beneficial community organizations and online support groups both nationally and at the state level who can provide families help and assistance when they move.