A small section of the Military Compensation and Retirement Modernization Commission report would have a substantial impact on a small segment of the military population — troops whose children have severe physical or intellectual disabilities.

The commission report, containing 15 recommendations to overhaul military pay and benefits, includes a proposal to change a Tricare program originally designed to offset the costs of caring for dependents with complex medical conditions.

The severity of the illnesses normally would qualify these dependents for Medicaid benefits that cover services only partially covered, if at all, by Tricare, like respite care, transportation, dietary products and medical equipment.

But Medicaid funds are administered by states, and since military kids make frequent moves with their families, they often end up at the bottom of state Medicaid program wait lists and can never access the benefits.

The compensation commission says Tricare's Extended Care Health Option, or ECHO, program, should be changed so it provides the same services as Medicaid, capped each year at $36,000, a move that commission members said would ensure continuity of care and keep families together.

"There are reported cases in which a military family member leaves a child to live in one state with a relative while the service member is assigned to a new installation," according to the report.

Changing ECHO could replace the need for these families to access Medicaid, panel members argued.

"Congress intended ECHO as an alternative to Medicaid waiver benefits.Yet as currently implemented, they are not robust enough. With the exception of home health care services and [autism] therapy, the ECHO program is not highly utilized. This is due to a lack of needed services," commission members wrote.

According to the report, 8,094 Tricare beneficiaries were enrolled in ECHO in 2013, about 6 percent of all families enrolled in the military services' exceptional family member programs.

Just 423 of those beneficiaries use ECHO for equipment, supplies, education and training services, at a total cost of $1.7 million.

The remainder — more than 7,000 beneficiaries — use the program to access home health care benefits or autism therapy, at a cost of $152.6 million in 2013.

The House and Senate held hearings in February on the commission recommendations, with several lawmakers expressing interest and support for the proposed changes to military health care, which include moving non-active-duty Tricare beneficiaries to a commercial insurance program developed exclusively to address their needs.

Sen. Kirsten Gillibrand, D-N.Y., was the sole lawmaker to raise concerns about the impact of the health care recommendations on families with special needs children.

Commission member Mike Higgins, a retired Air Force lieutenant colonel who served as a House Armed Services Committee staff member for 23 years, reassured Gillibrand that the panel "had a great deal of concern about exceptional family members and how we would care for them."

"We have a proposal that would add a new level of benefits for those families, one of those areas where we would increase cost, so we were not all about cutting. We were about making life better for service members," Higgins said.

The Children's Hospital Association and military families with special needs have pressed for changes to Tricare and Medicaid to improve services for these medically complex patients.

Association consultant Kara Oakley said children's hospitals were pleased to see the recommendation included in the panel's report, and noted that ECHO provides a platform for the Defense Department to serve these families better.

"Improving and updating ECHO to make more services available for these families, aligning it with Medicaid waiver and community care programs, would really help," Oakley said.

About Patricia Kime

Patricia Kime is a senior writer covering military and veterans health care, medicine and personnel issues.

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