Health Care/Special Needs

Whether this is your first move, or you’re a seasoned professional, moving can be a challenge. A little planning and preparation can help make your move as easy as possible. Try the following Defense Department resources to help you get organized:

• PCS & Military Moves on Military OneSource.mil provides comprehensive moving resources, information and services all in one simple location
• Plan My Move, an online tool that helps break down the moving process into clear, customizable steps, with checklists to help keep you organized and on track
• EFMP & Me, an online tool to help you plan for transition and continuity of support services for your family member(s) with special needs

Make sure your transition is as smooth as possible by visiting Moving on the TRICARE website. Talk to your medical case manager before you move. They can help you find a new doctor and other resources to avoid any interruptions in coverage.

On arrival at your new duty location, you or your sponsor can contact the Beneficiary Counseling and Assistance Coordinator at the military treatment facility. They can help if you have questions or need assistance with authorizations for TRICARE Extended Care Health Option, or ECHO, services.

All TRICARE regional offices and most military treatment facilities are staffed with beneficiary counseling and assistance coordinators who educate beneficiaries and help with TRICARE-related eligibility, enrollment, referrals/authorizations and claims processing questions. If you or your family has more complex needs, contact your TRICARE case manager.

TRICARE debt collection assistance officers are assigned to regional offices and military treatment facilities worldwide. DCAOs assist with confirmed debt collection due to unpaid TRICARE claims. Please note, the debt must be in collections or listed on your credit report.

Medicaid provides health coverage for eligible individuals and families with low incomes or with special needs. The department of social services or the department of medical assistance may administer the Medicaid program in your state. Supplemental Security Income is a cash assistance program intended to assist adults and children with special needs who have limited resources. Families must reapply after moving to a new state.

Medicaid waivers are state-specific Medicaid programs that provide funding for long-term care services to be provided in the community instead of in nursing homes or hospitals. There may be waitlists for waivers, however many states have agreed to the policy of allowing active-duty military families to enroll in their state of legal residence to get on the wait list.

Learn more about Benefits for Families With Special Needs, or review the Government Assistance Programs course on MilLife Learning.

The TRICARE Extended Care Health Option provides supplemental services to:

• Family members of active-duty service personnel (this includes activated National Guard and reserve service personnel)
• Family members who are covered under the Transitional Assistance Management Program
• Children or spouses of former service members who are victims of abuse and qualify for the Transitional Compensation Program
• Family members of deceased active-duty sponsors while they are considered transitional survivors.

The qualifying family member’s disability must be entered properly in the Defense Eligibility Enrollment Reporting System to have access to TRICARE ECHO services.

For qualifying medical and/or educational special needs, TRICARE ECHO offers integrated services and supplies beyond those offered by your TRICARE program option (such as TRICARE Prime and TRICARE Select). See this TRICARE ECHO factsheet for more information, or listen to this TRICARE ECHO webinar on Military OneSource.

Military hospitals and clinics are found at military bases and posts around the world. They are also referred to as military treatment facilities. Before you move, find out your new military treatment facility and contact them for local information.

Medical case management involves a team of health care professionals who help you and your family find solutions to complex health problems. It is important to let your medical case manager know if you are moving. They can help you connect with a medical case manager at your new location. Learn more about TRICARE case management services.

If your family member has special transportation needs for the move, such as oxygen or a special bed or wheelchair, contact your TRICARE medical case manager. They can advise you on equipment and transportation.

You can also contact your current installation’s household goods/transportation office (outbound) for information on special procedures for transporting medical equipment.

Eligibility for EFMP

A family member enrolled in the Defense Enrollment Eligibility Reporting System who has a diagnosed physical, intellectual, or emotional-psychological condition that requires ongoing specialized medical or educational services.

Enrollment in EFMP

Enrollment is mandatory once a special need is identified. Some common methods of identifying special needs are: family member clearance packages, assignment deferment process, the birth of a special needs child, self-referral and through agencies such as doctors, social workers, Commanders/First Sergeants and school officials.

Once the need is identified, an interview is conducted with the family by the Special Needs Coordinator to assess the extent of the special needs. This interview will identify the type of care that must be maintained or continued; ensure services are available and are being met through the base or within the local community; and to establish enrollment. Appropriate documentation such as medical summaries, Individualized Education Plans (IEP's) or Individualized Family Service Plans (IFSP's) must be submitted that clearly identify the need for enrollment. The sponsor is responsible for gathering and submitting these documents. Members will be assigned an Assignment Limitation Code of "Q" which serves as a "flag" to the AF military personnel center at Randolph of the possible need for special consideration in the assignment process. This does not prevent the member from getting an assignment. It can, however, provide for an initial deferment or reassignment. This will allow the member time to set up a medical treatment or special educational program.

Special needs fall into three main categories:

• General Medical Services (GMS) -- A variety of physiological or psychological conditions of a chronic nature that have been medically diagnosed and require specialized treatment. Examples include: hemophilia, leukemia, diabetes, asthma and mental health disorders.
• Special Educational Services (SES) -- A special instruction designed to meet the unique educational needs of the child. This includes education provided in school, at home, in a hospital or institution. These services are typically documented in the Individualized Education Plan (IEP) and are developed by the school and parents to ensure the program has been tailored to meet the particular needs of the child.
• Medically Related Services (MRS) -- Medically related services are required and listed in the Individualized Education Plan (IEP) or the Individualized Family Service Plan (IFSP). These services may include speech, occupational therapy and physical therapy. Audiology, social work, community health nursing and dietary assistance are also considered specialty services.

Special Assignment Considerations

All Air Force personnel must remain unencumbered and be able to respond to any contingency whenever called upon to do so. However, special assignment considerations are necessary when a care plan is being established. Air Force personnel are expected to establish their care plan and revert back to worldwide assignment status as soon as possible.

An EFMP deferment or reassignment is usually appropriate when the special need has been identified or a previously existing condition has developed new issues. An EFMP deferment from reassignment is typically requested to allow for initial establishment of a treatment program. Typically an EFMP reassignment is requested to be relocated to a location that can meet the needs of the dependent or when the projected assignment does not have adequate services. These assignment actions are not to be considered a base of preference program. Alternate assignment locations are based on both the current projected personnel requirements and the availability of care at military facilities or local civilian facilities utilizing a cost share arrangement.

Special assignment consideration is designed to ensure the availability of services and will continue as long as the need exists. A permanent or prolonged deferment from reassignment cannot be provided. The member must revert to worldwide assignment status once the care plan is in place.