News and Knowledge

On July 26, 2012, Federal District Court Judge Reggie B. Walton ruled in favor of the plaintiffs in the landmark case of Berge et al. v. United States of America, a class-action lawsuit initially filed by a retired Air Force couple.  Judge Walton called it both “arbitrary and capricious” that Applied Behavior Analysis (ABA), widely recognized by professionals as an effective therapy for people with autism, was only covered by TRICARE (the health benefits division of the Department of Defense) through a limited program.

Presently, ABA is listed as “non-medical education” under the Extended Health Care Option (ECHO) program; this allows TRICARE to restrict coverage to dependents of active-duty personnel at a maximum of $36,000 annually.  Because of the intensive nature of ABA therapy, it can cost tens of thousands of dollars more than what ECHO provides.  This places an undue financial burden on active-duty families, who are already dealing with the everyday complications of military life, and an even greater burden on the retirees (including wounded veterans) whose dependents with autism are not eligible for any ECHO benefits.

Pending any appeals from the Department of Defense, this ruling requires TRICARE to extend its ABA coverage to those who qualify under its basic program.  While there may be a lengthy implementation period, this is still a significant change in insurance practice that will certainly be welcomed by the families of more than 20,000 military children with autism.   This battle, however, is still being fought in legislatures throughout the country. There are still 17 states that do not mandate insurance coverage of ABA as a medically necessary treatment (Ohio passed legislation last week), leaving families with little to no access to this evidence-based intervention.

Operation Autism, a Web site developed by OAR to support military families, contains a constantly expanding resource directory that allows visitors to search for local resources (including ABA providers that accept TRICARE benefits) near their current or prospective bases.  For more information about OAR’s military families initiative, please contact Ben Kaufman, director, programs and community outreach, at 703-243-9762 or bkaufman@researchautism.org.