Medicaid waivers, respite care-and IEPS! Learn how the military healthcare system interacts with civilian healthcare and what military parents need to know about TRICARE services and Special Education.
The top four reasons parent center staff need to know about TRICARE, the military health care system are:
- Parent centers often have programs that help families navigate health care systems. Knowing the basics of TRICARE coverage for individuals with disabilities increases your capacity to help military families!
- Parent centers may provide information and advice to families on available supports and services through programs like Medicaid. TRICARE (also a federally funded program) interacts and has overlaps with Medicaid. You can answer families’ questions with the quick facts below.
- TRICARE programs may offer respite for family caretakers of eligible individuals. Being knowledgeable about military respite programs can help you refer families to the right people.
- TRICARE offers services and supports that parallel those provided through the school for an IEP, which and be confusing for military families.
Five TRICARE Facts
TRICARE & Medicaid:
- TRICARE and Medicaid are both federally funded programs, so the government regulates which program pays for benefits.
- Military family members can receive benefits from both programs. When a family member is enrolled in both, TRICARE is the primary payee (services are billed first to TRICARE). Medicaid is then billed for remaining costs.
- TRICARE offers the Extended Care Health Option (ECHO), which offers similar services to Medicaid Home and Community-Based Services Waivers (HCBS). Military families don’t keep their eligibility for HCBS Waivers when they move to a new state. ECHO benefits move with the family.
- Respite Care: For military dependents, respite care is available for eligible primary caregivers through two different parts of the ECHO program:
Up to 16 hours per week through “regular” ECHO
Up to 40 hours per week if the beneficiary qualifies for the ECHO Home Health Care program
Some military families are unfamiliar with ECHO and its full range of services, which may include rehabilitative services, assistive services, equipment, home health care, residential services, and respite.
Families can learn more about ECHO through their installation’s EFMP Family Support office and on the TRICARE website:
Contact numbers for EFMP at your state’s installations
TRICARE contact numbers
More on the ECHO program
TRICARE’s ECHO page
TRICARE’s ECHO Fact Sheet
More information on TRICARE and Medicaid
TRICARE ECHO eligibility and how to apply
ECHO Home Health Care
TRICARE services and IEP services:
5. TRICARE offers services and supports that may parallel those provided through the school for an IEP. It can be confusing for parents who don’t realize that the child must go through two evaluations/assessments to receive similar services, even though the services come from different sources.
The most typical services are occupational therapy (OT), speech-language therapy (SLT), and Applied Behavioral Analysis (ABA) therapy.
- TRICARE services, such as OT, SLT, and ABA therapies are based on a medical diagnosis and require either a prescription for or assessment from a TRICARE-authorized provider
- services are provided in the home or at a service provider’s office
As we know, school services are
- based on the evaluation performed when the parents or school request it for special education eligibility
- based on the child’s educational needs
- provided by the school system’s providers
The TRICARE-performed assessment can’t be used in place of the school’s evaluation (and vice versa); similarly, a prescription for speech therapy from a TRICARE provider is not sufficient to add speech therapy to a child’s IEP. Of course, parents can bring such medical recommendations to the IEP meetings as part of the IEP development.
Prefer viewing a set of slides to learn TRICARE basics, the ECHO program, and TRICARE ABA coverage?