Many MSJDN members have children who receive their health care through TRICARE, and some of our members are familiar with the process of navigating the military health care system to get proper care for their special needs children. These parents have been powerful advocates for their children in what can be a perfect storm of bureaucracy: a combination insurance company and government-sponsored program.

This is the first of a series about TRICARE for Kids. The first installment outlines the background and progress of the TRICARE for Kids initiative. Subsequent posts will profile military parents to share their stories and discuss how the proposed changes would impact their families.

Congress Calls On the DoD For TRICARE Reform

In March 2012, Rep. Steve Stivers (R-OH) introduced H.R. 4341, the TRICARE For Kids bill.
Congress recognized that a comprehensive review of TRICARE is necessary because the program is patterned upon Medicare – in other words, care for older adults — and the resulting policies do not always reflect appropriate standards for pediatric care. The bill acknowledged that TRICARE is currently not meeting the needs of children with disabilities, chronic and complex conditions, and other special needs.

H.R. 4341 directed the Department of Defense to create a working group to conduct an in-depth review of the TRICARE system with respect to pediatric health care needs. The working group is responsible for recommending changes to TRICARE’s policies that will ensure that children receive “appropriate care, in an appropriate manner, at the appropriate time, and in an appropriate setting.”

In December 2012, Congress passed H.R. 4310, the National Defense Authorization Act for Fiscal Year 2013. The NDAA included a provision directing the DoD working group –- key TRICARE personnel and stakeholders –- to conduct the TRICARE review and submit a report to Congress and the Secretary of Defense by the close of 2014.

The Military Special Needs Network’s TRICARE For Kids Report

The Military Special Needs Network, in conjunction with the MOAA, National Military Family Association, and other health care professionals and family and disability advocates formed a committee to conduct their own review and analysis of TRICARE’s policies concerning special needs children and exceptional family members. Most importantly, the committee reached out to hundreds of military families to gather information about special needs children who were denied or experienced significant barriers to accessing the treatments and therapies they need. The committee recently finalized a report and submitted it to be implemented in the DoD working group’s final report to Congress.

If the DoD and TRICARE accept the analysis and recommendations in the report, pediatric care will become more efficient and much easier for families to navigate. The Report recommends change in several key areas, including:

• Making it less onerous for providers, especially specialists, to participate in the TRICARE program
• Covering treatments that are considered emerging technology
• Removing barriers to access to state Medicaid programs
• Utilizing children’s hospital systems to provide case management for children with medically complex conditions

One of the most striking and disappointing aspects of the Report is the widely reported difficulties families experienced with getting PCMs and EFMP coordinators to connect them with providers and specialists, either because TRICARE would not approve referrals and treatments or because, in the case of EFMP coordinators, they did not have the right training.

Coming soon: stories from parents, including MSJDN members, about their experiences with TRICARE. MSJDN stands in support of the Military Special Needs Network in its efforts to help reform the TRICARE system for the benefit of all military children, particularly those with special needs.

Want to share your experience navigating TRICARE for Kids for a special needs child? Email TRICAREstories@msjdn.org.