Military Families Ask Congress to Fix TRICARE

WASHINGTON, DC (April 9, 2014) -- Military families raising children with autism and Down syndrome today called on Congress to overhaul insurance coverage provided under TRICARE for applied behavior analysis (ABA) during Capitol Hill briefings organized by Autism Speaks. Reps. John Larson (D-CT) and Tom Rooney (R-FL), who have championed TRICARE reform bills in the past, said they remain committed to improving ABA coverage for military kids and will soon introduce new legislation.

Kimberly Kapacziewski [left], whose son Cody, has been diagnosed with autism, came to Washington from Fort Benning, Georgia, where her husband, Joe, serves as a sergeant first class with the Army Rangers. Kapacziewski lost the bottom part of a leg to a hand grenade while serving his fifith tour in Iraq in 2005, but later returned six times to active duty with the Rangers as an amputee.

Patricia Heath [right], whose daughter Marissa has been diagnosed with Down syndrome, is stationed at Eglin Air Force Base in Pensacola, Florida with her husband, Brandon, an Army master sergeant.

They were joined by Dr. Paul Wang, Autism Speaks' head of medical research, and Karen Driscoll, Autism Speaks' associate director for federal government affairs and military relations. The wife of a retired Marine, her son has autism.

Kapacziewski said she and her husband had to travel to an Army base in Texas simply to find a pediatric specialist who could diagnose their som with autism. Medical professionals said Cody needed a minimum of 25 hours a week of ABA therapy, but TRICARE caps benefits at 12 hours.

"Her husband has already sacrificed a leg for his country, does he have to sacrifice a child too?" Larson said.

Heath said her daughter received three years of ABA therapy and was making tremendous progress when TRICARE cut off all benefits in 2012 by limiting coverage to children with autism, excluding those with Down syndrome, Fragile X, Angelman syndrome and other developmental disabilities. Her daughter soon regressed and once briefly wandered from home.

Driscoll said advocates or TRICARE reform are calling for ABA coverage to be made permanent for all children with disabilities, expanded access to treatment by allowing more trained providers to deliver reimbursable services, and continued vigilance over the Department of Defense to insure military dependents receive care that is consistent with best practices.

Wang cited the continued growth in the prevalence of autism which now affects an estimated 1 in 68 children. The benefits of ABA in treating autism and other developmental disabilities has been amply documented, he said, noting a recent endorsement before Congress by the American Academy of Pediatrics.