By Rose L. Thayer
Fort Hood Herald
Prepared to remain in the military indefinitely, Lt. Col. Chuck May is determined to get his children the health care they need.
"I would stay in the Army well beyond 30 years if I knew I could have my family covered with TRICARE," said the officer in Fort Hood's Operational Test Command. "I don't care about pay raises, and I don't care about promotions."
May's sons, ages 11 and 14, have been diagnosed with forms of autism spectrum disorder. In the year before TRICARE covered any autism treatment, the May family spent $19,000 on therapy for just one of his sons.
Now TRICARE offers autism therapy through the Extended Care Health Option, but only active-duty service members are eligible to participate. If May retires, his sons lose the coverage.
"It's a really skewed system," said Stuart Spielman, senior policy adviser and counsel for the advocacy group Autism Speaks. "The people who've served the most, who are retiring after many years of service, or maybe retired because of war wounds, they won't have access to benefits."
But the coverage discrepancy would disappear if a new congressional bill became law. Sponsored by Rep. John Larson, D-Conn., and now in committee, the Caring for Military Kids with Autism Act would make autism treatment, called applied behavior analysis, available to retirees.
"We are mighty proud of our TRICARE system and to leave a gap in this system seems to be wrong," said Rep. John Carter, R-Round Rock, who is co-sponsoring the bill along with 54 other representatives. "That's not the kind of burden we should give. We should try to give effective health care to those families. They've earned it, and they're entitled to have it."
Many local military families seek treatment at the Harker Heights location of Kansas-based Autism Concepts, which provides applied behavior analysis.
"We teach kids how to learn," said Ian Santus, regional director for the behavioral consulting company.
Applied behavior analysis, said Santus, is the only empirically based treatment for people with autism. During the sessions, therapists work with children to modify behaviors of social significance. Parents are encouraged to watch the one-on-one sessions and implement them at home.
Hard to afford
But many active-duty military families are struggling to afford the difference between the treatment their children need and TRICARE's coverage limits.
The American Acadmey of Pediatrics recommends a minimum of 25 hours a week for autism therapy, but TRICARE coverage has a $3,000-a-month cap, which pays for about 10 to 14 hours of treatment a week.
Six-year-old Broden Huhtanen is one of about 390 autistic family members at Fort Hood, according to information from Carl R. Darnall Army Medical Center. He was prescribed 40 hours of treatment a week. But at nearly $10,000 a month, his mother, Shelly Huhtanen, said it's impossible to afford.
"We are going to put him more in school next year and less in clinic," said Huhtanen, whose husband is a major in the 1st Cavalry Division. "We just can't afford it. We'd go into debt."
Broden attends a private pre-school four hours a day and spends about 26 hours a week at Autism Concepts.
Huhtanen's husband has deployed three times, which she said benefitted the family because of the extra income and respite care. "It's awful that he's gone, but we'll be able to provide more for our children," she said.
In 29 states, including Texas, insurance companies are required to cover applied behavior analysis, but TRICARE is federal and overrides state laws.
"I think (TRICARE) is falling behind now," said Spielman. "What we are seeing in state after state is this trend to providing what's necessary coverage for an affected individual."
If the congressional bill passes, active-duty military families, such as the Huhtanens, will benefit because the federal legislation would move the autism therapy from the Extended Care Health Option into standard TRICARE coverage.
Switching autism therapy to regular coverage also will end the hoops military families must clear to join the extended health option.
Families now must first get their children registered with the Exceptional Family Member Program, which makes sure the military doesn't send families to installations where they cannot get the medical and educational support they need, said Dr. Glynda W. Lucas, medical director of the program.
Besides autism, exceptional family members are diagnosed with potentially life-threatening or chronic diseases, such as seizures, mental illness, asthma and attention deficit disorder. Enrollment in the program takes between five and six weeks. Once children are registered, their families can join TRICARE's optional coverage, which lists applied behavior analysis as a special education service.
"It is important to note that (applied behavioral analysis) is still not considered to be proven medical treatment for autism, based on current reliable evidence as that standard is defined for TRICARE by law and regulations, and thus applied behavior analysis is still prohibited by law from being covered under the basic TRICARE medical program," said Austin Camacho, a TRICARE spokesperson in an email.
Contact Rose L. Thayer at firstname.lastname@example.org or (254) 501-7463. Follow her on Twitter at KDHreporter.