August 9, 2022

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Military Personnel: Opportunities Exist to Improve Access to Services Supporting Caregivers of Dependents with Special Needs

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What GAO Found

The Department of Defense (DOD) offers eligible military families several services to support caregivers of special needs dependents. Stakeholder organizations GAO interviewed identified these services as key to supporting caregivers, particularly respite care—in which a provider temporarily cares for the special needs individual. Through the TRICARE Extended Care Health Option (ECHO) program, active duty military families with special needs dependents may obtain respite care, care coordination, training, and some supplemental services. Military families may obtain additional support services through their military branch’s Exceptional Family Member Program (EFMP) or state Medicaid programs. However, services available vary by military branch and by state.

Department of Defense (DOD) Programs Supporting Military Members’ Dependents with Special Needs and Their Caregivers, 2021

Department of Defense (DOD) Programs Supporting Military Members' Dependents with Special Needs and Their Caregivers, 2021

Note: Numbers are rounded to the nearest thousand. For more details, see fig. 1 in GAO-22-105204.

DOD has recently taken steps to address two policy barriers to accessing respite care. In 2021, DOD issued a rule eliminating the requirement for ECHO enrollees to receive a concurrent benefit (e.g., incontinence supplies) to qualify for respite care. DOD is also taking steps to increase the number of respite care hours from 16 to 32 hours per month. DOD officials expect to implement this by 2025.

However, GAO found that Defense Health Agency (DHA) officials miscommunicated requirements for accessing ECHO respite care to EFMP officials, who help refer families to resources like ECHO. Specifically, DHA officials informed EFMP officials of a requirement that another adult remain present during the provision of ECHO respite care. DHA officials told GAO that this is not a TRICARE policy, rather that some home health agencies require this out of concern for the dependent’s safety. EFMP officials from one military branch stated that this requirement effectively renders the respite care benefit unusable for eligible families. In addition, GAO found that DOD does not have data on the extent of unmet need for ECHO respite care. TRICARE’s two managed care support contractors—the entities responsible for coordinating respite care—collect some data on unmet need for ECHO respite care. However, these data are limited and the contractors are not required to report it to DHA. As such, DHA cannot assess why, in 2021, only about half of ECHO enrollees authorized to receive respite care (175 out of 341) ultimately utilized this benefit and cannot identify strategies for increasing access to this benefit.

Why GAO Did This Study

Caregivers of dependents with special needs can experience negative consequences from their caregiving roles, such as stress and lost wages. Military families with special needs dependents face additional caregiving challenges due to frequent moves to new duty stations. To address the needs of these military families, DOD provides caregiver support services, such as respite care, through its military branches and the TRICARE health care program. Congress included a provision in statute for GAO to review certain caregiving services available to military families. This report (1) describes respite care and other key services for supporting caregivers available to active duty military families through ECHO and other programs, and (2) examines barriers military families may face when seeking to access respite care and actions DOD has taken to address those barriers.

To perform this work, GAO reviewed DOD program policies regarding caregiver benefits. GAO also interviewed DOD officials, TRICARE representatives, state Medicaid officials, and stakeholder organizations representing military families and the special needs community.

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