Retired Navy Lt. Cmdr. Anthony Putney recalls often waiting for months before his severely disabled daughter Lily could be enrolled in Medicaid after they made the military move from state to state.

That meant no health coverage for a private duty nurse or for expensive necessities such as adult diapers and equipment, things that weren’t covered by Tricare.

“During those time periods it was very stressful, which impacted my military readiness,” he said.

He remembers those stressful times, such as when his wife would call him at work, in tears, and he could hear Lily in the background.

“Lily was wailing, and I’m at a dispatch center working as an air traffic controller trying to get F-18s, F-14s off the ground, and I’m dealing with that at work," he said. "Or I’m calling insurance companies or fighting with insurance companies about paying. And I’m trying to explain this to my supervisors or need time off from work.”

In the midst of discussions about cutbacks to Medicaid, advocates have issued a new report highlighting the importance of this program to about 3.6 million military-connected children nationwide. The vast majority of those — about 3.4 million — are children of veterans. About 200,000 are children of active-duty or retired service members, according to the report.

Cutbacks to Medicaid result in less access to these needed programs and services. And, compared to Medicare, the national health care program for those 65 and older, Medicaid reimbursement rates are lower, according to the report.

Improvements are also needed in access to Medicaid, a long-standing problem for military families like the Putneys who move frequently, according to the report, "America’s Military Readiness and the Essential Role of Medicaid,” published by the Tricare for Kids Coalition.

Medicaid plans are administered by each state, so families encounter “vastly different” programs each time they move across state lines. It’s especially difficult for families with children with complex or chronic medical conditions who rely on Medicaid home- and community-based services.

Medicaid is a program funded by the federal government and the states, which provides health coverage to disabled and lower-income Americans, including about 37 million children across the country. Nearly half of the country’s children are on Medicaid.

“Medicaid is an essential program for the children of today’s military-connected families, and an essential program for children who serve in tomorrow’s military,” according to report.

“One reason we delved into this research as a coalition is because Medicaid was under such threat on the Hill these last couple of years,” said Kara Oakley, chairwoman of the Tricare for Kids Coalition, during a call with reporters. “We had a grassroots swell of concern from the families.”

The coalition includes a number of children’s health care advocacy and professional organizations, disability advocacy groups, military and veteran service organizations and military families.

Among those 200,000 children of active or retired service members who are using Medicaid and also enrolled in Tricare, it’s not known how many are active-duty families and how many are families of retirees, said Mark Wietecha, president and CEO of Children’s Hospital Association.

He said there are some misperceptions about Medicaid.

“Medicaid is not just a broad health insurance program for poor people," he said. "It’s the most specialized pediatric health care program in the country. There are specialized pediatric programs [for chronic or sicker kids] that Medicaid can coordinate and offer, that are just not available through other insurance plans.”

That includes commercial insurance plans as well as Tricare, he said.

Beyond the tens of millions of children across the country who are in Medicaid directly, “there are many thousands of commercially insured kids in Medicaid wraparound programs,” for children with these chronic conditions, Wietecha said.

“Tricare is great for well kids, and I can say that for my other children. But if you have any kind of chronic problem, such as cancer, diabetes, endocrine, any kind of genetic problem, any kind of brain or developmental disabilities, Tricare is not good,” said Putney, whose daughter Lily is on Medicaid.

Lily, now 20, was a developmentally typical 15-month-old before an ear infection spiraled out of control when the family was stationed in Japan. She was hospitalized for five months at various locations in the U.S. and suffered more than 50,000 seizures.

Medicaid became critical in filling the gaps of what Tricare didn’t cover, said Putney, who, inspired by Lily, later became a nurse.