Less than 24 hours after NBC News reported on members of the military and retirees facing roadblocks in getting coverage for critical therapies for children with autism, Sens. Kirsten Gillibrand, D-N.Y., and Eric Schmitt, R-Mo., issued a letter Friday to Pentagon leadership calling for changes.
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Gillibrand and Schmitt are members of the Senate Armed Services Committee, which oversees the Defense Health Agency and TRICARE.
The letter calls on Defense Secretary Peter Hegseth to get rid of rules in the TRICARE program that are causing parents to be denied some Applied Behavior Analysis, or ABA therapies, that are typically covered by most private and public insurance. ABA therapy is used to help children communicate and learn daily life skills.
In the NBC News report, the military’s healthcare program restricted coverage for the behavioral therapy for a 10-year-old boy with a severe form of autism. The boy, Logan Cabiao, who is nonverbal and needs round-the-clock supervision and care, gets TRICARE through his father, Mario Cabiao, a retired air force pilot. Logan had been receiving ABA therapy for several years, which had been “life-changing” for the family, his mother Kristi Cabiao said.
But in 2021, TRICARE added new requirements for ABA coverage and significantly narrowed the range of services provided, along with roadblocks to access.
Friday’s letter urged the Dept. of Defense to make ABA therapies a basic benefit under the TRICARE program.
“It is unacceptable that military families are being denied essential care for their autistic children,” Sen. Gillibrand said in a release Friday. “By refusing to provide ABA therapy as a basic medical benefit, TRICARE is failing our service members and forcing overwhelmed families to navigate a frustrating bureaucratic maze just to secure limited life-changing care.”
Kristi Cabiao founded a nonprofit to lobby lawmakers to enact these changes.
“I’m excited to see that they are supporting publicly and pushing for the DOD to implement these changes,” she said Friday. “I’m really excited to see how immediate they responded to your report.”
Cabiao, who meets with lawmakers on Capitol Hill frequently, said she last visited in March. She said key lawmakers told her “the budget’s tight, DHA doesn’t have enough money to cover services, and it’s just not going to happen this year.”
Sens. Gillibrand and Schmitt have always been supportive of ABA benefits for TRICARE beneficiaries, Cabiao said. “Those two have not wavered.”
Both Gillibrand and Schmitt were part of the push for an independent analysis by the National Academies of Sciences, Engineering and Medicine, which recommended TRICARE update its coverage policies to include ABA as a basic benefit.
The Defense Health Agency, which oversees the TRICARE program, declined to comment for the initial NBC News story and did not immediately respond to questions about Gillibrand and Schmitt’s letter.
Thousands of other service members and their families have experienced disruptions and hurdles to medical care since changes to the military program. NBC News reported last month that many TRICARE beneficiaries in the Western region faced challenges with coverage, including billing errors, delayed reimbursement and denied claims, after the Defense Health Agency changed over the contractor responsible for administering benefits. The contractor, TriWest Healthcare Alliance, later issued a public apology for problems with its coverage. The Defense Health Agency is part of the Defense Department.