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.

The purpose of the Special Needs Identification and Assignment Coordination Process/ Exceptional Family Member Program (EFMP) is to identify family members with special physical, emotional, medical, or educational needs and to coordinate appropriate assignments. All active-duty personnel with family members with special needs are required to enroll.

Assignments, to include reassignments and deferments, are coordinated through this office to ensure the family is assigned to a location that has services to meet their needs. The EFMP office can also provide information on military and community resources to help families transitioning to new locations.

Military sponsors with a special needs family member must enroll in this program to ensure services can be provided at future assignments and to ensure all services that family members qualify for are being implemented.

Enrollment Criteria

Potentially life-threatening conditions or chronic (i.e., duration of 6 months or longer) medical or physical conditions requiring follow-up care from a primary care manager (to include pediatricians) more than once a year or specialty care.

Current and chronic (i.e., duration of 6 months or longer) mental health conditions (e.g., bipolar, conduct, major affective, thought or personality disorder) requiring inpatient or intensive (i.e., greater than one visit monthly for more than 6 months) outpatient mental health service within the last 5 years, or requiring intensive mental health services at the present time. This includes medical care from any provider, including a primary care manager.

A diagnosis of asthma or other respiratory-related diagnosis with chronic recurring symptoms that involves one or more of these conditions:
(1) Scheduled use of inhaled or oral anti-inflammatory agents or bronchodilators;
(2) History of emergency room use or clinic visits for acute asthma exacerbations or other respiratory-related diagnosis within the last year; or
(3) History of one or more hospitalizations for asthma or other respiratory-related diagnosis within the past 5 years. 

 A diagnosis of attention deficit disorder or attention deficit hyperactivity disorder that involves one or more of these conditions:
(1) Includes a comorbid psychological diagnosis;
(2) Requires multiple medications, requires psycho-pharmaceuticals (other than stimulants), or does not respond to normal doses of medication as determined by a medical provider;
(3) Requires management and treatment by a mental health provider (e.g., psychiatrist, psychologist, social worker, or psychiatric nurse practitioner);
(4) Requires the involvement of a specialty consultant, other than a primary care manager, more than twice a year on a chronic basis; or
(5) Requires modifications of the educational curriculum or the use of behavioral management staff.

A chronic condition that requires:
(1) Adaptive equipment (e.g., an apnea home monitor, home nebulizer, wheelchair, custom-fit splints/braces/orthotics (not over-the-counter), hearing aids, home oxygen therapy, home ventilator);
(2) Assistive technology devices (e.g., communication devices) or services; or
(3) Environmental or architectural considerations (e.g., medically required limited numbers of steps, fenced yard, wheelchair accessibility, or housing modifications and air conditioning).