A congressional watchdog agency has recommended that the Defense Department assess the coverage limit of a healthcare program that provides services to military dependents with special needs. (Creative Commons)
A Tricare program that provides services to military dependents with special needs is overdue for a review of its coverage limit, which has stayed the same for more than 15 years.
That’s the conclusion of a new Government Accountability Office report regarding the Extended Care Health Option in the military’s medical insurance plan.
Because the program’s coverage limit hasn’t changed since 2009, it may not be on par with that of other programs such as Medicare, and may not be meeting the needs of enrollees, according to the report issued Monday.
Tricare covers uniformed service members, retirees and their families. Dependents of active-duty service members with special medical or educational needs must be enrolled in the Exceptional Family Member Program to receive specialized care.
The program provides services and supplies for dependents with conditions like autism, cerebral palsy or severe intellectual disabilities. It has about 27,000 people enrolled, the GAO said.
Increasing numbers of plan members have been approaching the $36,000 coverage limit, the report said, adding that some enrollees want to make requests that go over the limit but are instructed to prioritize the items they need now.
In addition, the program’s home health care benefit offers in-home medical services to homebound military dependents with complex medical conditions. The report puts the number of recipients of that benefit at about 1,000.
Three major focus areas were addressed by the GAO: habilitative services, nursing and respite care.
The GAO flagged several issues with respite care, the most requested service in the program.
Respite care provides temporary relief for caregivers by having another provider look after a dependent with special needs.
According to the report, families often struggle to find providers willing to accept ECHO respite-care assignments.
Of the 734 authorizations approved for respite care between 2022 and 2024, less than one-third were used, the report said.
According to case managers interviewed by the GAO, one reason is that providers often want more hours than ECHO currently offers. Tricare’s reimbursement rates may also be less competitive than some private insurance options, according to the GAO.
The Defense Department plans to review ECHO benefits and is standardizing eligibility requirements and the number of covered respite care hours offered across service branches, the report said.
