Navigating the Complexities of Military Healthcare for Children

Are Parents Left to Sink or Swim?

Feb 06, 2024

∙ Paid

There were more than a few tears shed during the most recent Military Dinner Table Conversations. While individuals may be frustrated at the circumstances they face finding health care for themselves, not being able to access care one’s children is having a significant impact on the mental health of military families. In a poignant session of Military Dinner Table Conversations, families within the military community shared their challenges accessing healthcare for their children. We were joined by Kara Tollett Oakley, founder of the Tricare for Kids Coalition, who shared updates from the Coalition and helped point parents to available resources and legislation intended to correct some of the challenges they face. Parents became storytellers, shedding light on how they believed things could be improved.

While this summary does its best to capture these conversations, there is so much more to share. Be sure to continue to the end to watch the recording.

Here's a closer look at the main themes that emerged from our Conversation:

Session 1: Heartfelt Struggles

The conversation began with Michelle, a parent whose frustration with the healthcare system encapsulated the struggles of many on the call. She described the hardships of finding providers willing to accept TRICARE. "You just have to pray that someone will reach out to you," she shared. Other participants highlighted how they are forced to navigate a new healthcare landscape every two to three years, but each new step may still feel like uncharted territory.

This newness can be exacerbated for families whose children experience a new diagnosis. "The struggle for us was when our child was finally diagnosed with dyslexia,” shared a participant named Amanda. “No one really wants to recognize dyslexia." Another parent who is still on active duty mentioned how little communication seemed to be a part of the diagnostic process. They reported both being left without resources or next steps after their child’s initial autism diagnosis at the age of six. They also were not given next steps or resources for their child after being denied care from a Child Development Center due to autism-related behavioral issues.

A pivotal moment in the discussion came when Austin Carrigg, founder and CEO of Exceptional Families of the Military and EFMP parent, shared a personal anecdote that reflected how a recent DoD policy update can impact families. She observed Military Treatment Facilities' efforts to “recapture” children into the military healthcare system, may be happening without full consideration as to what is least disruptive for patient care. This policy “about face” was updated in a memo from Deputy Defense Secretary Kathleen Hicks designed to “re-attract” roughly 7% of those receiving benefits through TRICARE, but would have previously been treated at military treatment facilities (MTFs). This comes after years of talk that the military was going to cut roughly 18,000 military medical billets and push family medical care into the community, a plan that was met with skepticism. Austin’s story shared that some of those who have been “recaptured” may not be receiving the same care as they were “in town” as not all medical professionals in a specialty area are trained to care for pediatric patients.

This revelation raised concerns about the lack of transparency regarding providers' qualifications, with some participants sharing that their child had been assigned to a generalist when they needed a specialist. This perceived lack of transparency was also mentioned when dealing with sensitive issues like gender-affirming care.

The conversation also touched on disruptions caused when MTF providers PCS mid-assignment, accessing telehealth, and recent changes to pharmacy benefits. Participants shared they experienced difficulties in obtaining specific medications and having to pay out of pocket without much notice when local pharmacies no longer accept TRICARE. A participant emphasized, "The pharmacy benefit has really gone downhill in the past two years."

As the town hall progressed, individuals shared stories about accessing gender-affirming care for their children. Attendee and military parent, Cathy Marcello, who is also the Program Director for the Modern Military Association of America (MMAA), voiced her concern about a behavioral health provider's suggestion to delay gender-affirming care until other mental health issues were resolved, something that was brought up by a participant. She emphasized that such advice contradicts best medical practice and raised questions about the transparency of healthcare providers' qualifications. This intersection of gender-affirming care and mental health underscored the need for comprehensive solutions that align with the best interests of military children and their families.

Session 2: Navigating a Maze of Healthcare Challenges

In the second session of Military Dinner Table Conversations, the discussion examined on other key issues such as the Exceptional Family Member Program (EFMP), access to specialized care, changes to TRICARE health care coverage, medication delivery and the impact of the Autism Care Demonstration (ACD).

One participant expressed frustration with the EFMP enrollment process. Parents described scenarios that seemed similar to navigating a maze blindfolded–stacks of paperwork, changing policies and inconsistencies across different installations overwhelmed many families. Despite some being enrolled in EFMP, families were unclear how EFMP fit into the process and who, if anyone, is responsible for helping families through these complexities.

Although families observed a lack of process and clarity, they also expressed concern that the DoD has access to a lot of personal data that may or may not be being used to inform programs. One example is the Autism Care Demonstration (ACD). TRICARE’s ACD covers applied behavior analysis (ABA) services. Under the ACD, ABA services are authorized to target the core symptoms of autism spectrum disorder (ASD). The ACD is authorized to run through Dec. 31, 2028. One aspect of the ACD that was brought up during the Conversation was a required survey called the Parent Stress Index (PSI). The intent of the PSI questionnaire is to help practitioners advise parents about how they can support their children in a manner that compliments practitioner strategies. However, this PSI asks questions like, “If I had to do it all over again, I might decide not to have child(ren).” Participants shared that they have not felt as though this invasive data has been used to benefit them and ended up being an invasion of privacy by military practitioners.

Recent TRICARE changes may have disrupted medication delivery for some, causing unnecessary stress. As was indicated in the first Conversation, families expressed concern about accessing pharmacy benefits through Express Scripts. While some mentioned they were able to get prescriptions filled by the mail-order pharmacy in a timely fashion without issue, this only applied to relatively predictable medical needs. However, for military families with children whose needs may be evolving, due to a new diagnosis or changes to prescription levels, the Express Scripts program may feel like more of a headache than a benefit.

In conclusion, these sessions of Military Dinner Table Conversations provided a candid glimpse into the challenges faced by military families in navigating the healthcare system for their children. And in talking to guests, a prevailing theme emerged—military families are in need of greater transparency into complex policies and processes, an improved handoff between medical and health insurance providers and military resources, and comprehensive solutions to assist military families seeking specialized care despite the nationwide provider shortage.

Instead of throwing families into the deep end hoping they find their way to the surface, they need to be taught how to swim, given safety gear and supervision to make sure they are thriving, not just surviving.