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.

Exceptional Family Member Program (EFMP)

EFMP ENROLLMENT CRITERIA

A SPECIAL MEDICAL NEEDS - If criteria met, complete a DD 2792.

1. Potentially life-threatening condition or chronic (duration of 6 months or longer) medical or physical condition requiring follow-up from a primary care manager (to include pediatricians) more than once a year or specialty care. (Examples: High-Risk Newborns, Sickle-Cell Disease, Insulin-Dependent Diabetes, Cancer in the last 5 years).

2. Mental health condition (Examples: Bipolar, Conduct, Major Affective, Thought/Personality Disorders) which meets one of the following criteria:

• Current and Chronic (>= 6 months duration) mental health condition.
• Inpatient or Intensive (>1 visit/month for more than 6 months) outpatient mental health service within the last 5 years.
• Intensive (> 1 visit/month for more than 6 months) mental health services required at present time. This includes medical care from any provider including a PCM.

3.   Asthma or other respiratory-related diagnosis with chronic recurring symptoms which meets one of the following criteria:     

• Scheduled use of inhaled or oral anti-inflammatory agents or bronchodilators.
• Hx of ER use or clinic visits for acute asthma exacerbations or other respiratory-related diagnosis within the last year.
• Hx of one or more hospitalization (or ICU admission) for asthma or other respiratory-related diagnosis within the past 5 years.

4.  ADHD or ADD that meets one of the following criteria:

• Includes a co-morbid psychological diagnosis.
• Requires multiple medications, psycho-pharmaceuticals (other than stimulants) or does not respond to normal doses of medication.
• Requires management and treatment by mental health provider (e.g. psychiatrist, psychologist, social worker, psychiatric nurse practitioner…).
• Requires the involvement of a specialty consultant (other than a family practice physician) more than twice a year on a chronic basis.
• Requires modification of the educational curriculum or the use of behavioral management staff (IEP).

5.   A chronic condition that requires:

• Adaptive equipment (such as an apnea home monitor, home nebulizer, wheelchair, custom-fit splints, braces, and orthotics (not Over-the-counter), hearing aids, home oxygen therapy, home ventilator…).
• Assistive technology devices (such as communication devices) or services.
• Environmental or architectural considerations (such as medically required limited number of steps, wheelchair accessibility, housing modifications, air conditioning…).

SPECIAL EDUCATIONAL NEEDS - If criteria met, complete a DD 2792-1.

Family Member has or is found eligible for either an IFSP (Individualized Family Service Plan = enrolled in EDIS) or an IEP (Individualized Education Program) in accordance with DODI 1342.12 and DODM 1342.12.

For any questions, contact the Baumholder EFMP/FMTS Case Coordinator at DSN: 314-590-1130, CIV: 06371-9464-1130.

Email address: usarmy.landstuhl.medcom-lrmc-mbx.bhhc-efmp@mail.mil

Exceptional Family Member Program (EFMP) Army Community Service (ACS) Family Support

Active Duty Families enrolled in EFMP are eligible to receive support and services from EFMP ACS to include:

• Assistance with Command Sponsorship
• Assistance with Compassionate Reassignment
• Non-Clinical Case Management
• Support Groups
• Coordination of Services throughout Transitions
• Assistance with IEP/504 Services
• Assistance in securing special needs accommodations in Children and Youth Services

For more information, contact the Baumholder EFMP ACS system navigator at DSN: 531-2877, CIV: 0611-143-531-2877