Panel investigates military family TRICARE complaints

The House Armed Services Committee is investigating complaints from military families who claim the Pentagon's revamped TRICARE healthcare system is failing to adequately cover families with special-needs children.

Early this month, several committee members, including House Armed Services Committee Chairman Duncan Hunter, R-Calif., visited troops at Camp Lejeune, N.C. While there, one family told lawmakers recent changes in TRICARE contractors "has made it difficult for large numbers of special needs children to get through," according to Rep. Heather Wilson, R-N.M., one of the lawmakers who visited the base.

Camp Lejeune is home to more than 43,100 troops including Marines and Navy. It also houses 53,545 family members. The base's Exceptional Family Members program is comprised of 750 Marine Corps and 125 Navy families with special-needs children.

At the committee's request, the Defense Department is now investigating the complaint, which congressional sources say could stem from the change in TRICARE contractors.

One source said it is not uncommon for a new contractor to review coverage provided to healthcare beneficiaries, or to make changes. "It's possible that the new contractor is right to review the coverage, because somebody has to be protecting the taxpayer," one congressional source familiar with TRICARE said. "It is also possible that the situation has changed between the contractors, and what was once a medical case has stopped progressing medically and become a custodial care situation."

In these cases, the healthcare contractor could reduce benefits for homecare services that do not require skilled nursing or other medical care.

Although the Pentagon has traditionally been supportive of service members and families with special-needs children, the department is banned by law from providing coverage for such custodial care. Families experiencing changes in their coverage under the new TRICARE system can still receive state-administered benefits through Medicaid. However, such coverage is limited and would be terminated if the military beneficiaries were relocated to another state. "They would have to start all over again with Medicaid in a new state," the congressional source said.

Molly Tuttle, a spokeswoman for Health Net Federal Services, the TRICARE contractor whose region includes military service members and their families at Camp Lejeune, said the company has received no complaints regarding coverage of special-needs children.

"We will have a provider group and a government relations group to look into it," Tuttle said. "But when we changed contracts, we brought the same network from the previous contractor."

Tuttle said the company is working to enhance the existing network by adding providers and in some cases renegotiating reimbursement rates. "I am not aware of anyone not getting their care," she said.