Military Families
9:34 am
Wed November 27, 2013

Patty Murray Twists Arms Over Military Families' Health Coverage

Some military families can’t get treatment for their children with developmental disabilities, even if it’s prescribed by a doctor. Washington’s senior senator hopes to force a change, even though her efforts have fallen short once before.

The controversy revolves around a therapy called Applied Behavior Analysis, which is widely used to treat children with autism by reinforcing desired behaviors. Tricare, the military insurance provider, does cover it for children diagnosed on the autism spectrum. But the therapy is being prescribed more and more to children with other disabilities, and those populations are not covered.

That poses problems for families like Miranda Fort’s, whose husband serves in the Navy. Military insurance covers Applied Behavior Analysis, or ABA, for her 3-year-old son Teagan, who has autism.

“A year ago, my son wouldn’t be able to be in this room. The sounds from in here, he wouldn’t be able to cope with. ABA has taught him the coping skills to behave appropriately in town,” she said.

Doctors have also prescribed ABA for her 5-year-old daughter Josie, who has a brain malformation. But there, the Forts are on their own and can’t afford to pay for the therapy out-of-pocket.

Sen. Patty Murray, D-Wash., has introduced legislation to force military insurance plans to cover the therapy for any child with a prescription.

“When your spouse is out serving our country you shouldn’t be home fighting your insurance company,” Murray said.

Her amendment would cost about $60 million. It’s the second time Murray has taken a run at this issue. The first time it got negotiated down to a pilot project that expanded coverage to more families, but still leaves out kids without an autism diagnosis.

The Defense Health Agency, which runs Tricare, said in a statement that it provides one of the most generous ABA benefits in the country, and will continue to study the issue.

Some insurance companies have resisted paying for Applied Behavior Analysis for diagnoses besides autism because the therapy is less well-supported by scientific evidence for those conditions. But Murray said most states, including Washington, already require health plans to cover ABA. It’s only fair, she said, that the military plans do the same.