Parent Feedback

I understand that changed takes time but not at the expense of the health and care of the beneficiaries. This change came in and our provider who is in the naval hospital didn't even know it happened make it a lapse in time for care. Things have resolved since December but still the regression my child suffered due to this change has changed the family dynamic and our lives overall. –Marines California

For the first time in 20 years of service, I am dissatisfied with my benefits. I now have anxiety and depression as I feel trapped in service that doesn't adequately care for my son. To further pile on, tricare has erroneously denied 31 ABA claims over the last 18 months. My assigned ACD complaint officer is not helpful. My provider has been incredibly flexible, patient and understanding; however they still need to be paid for their services. I spend a good portion of my work day, researching claim status, CPT codes, modifiers, points of services, units, etc. There's never any consistently as to how tricare approves/denies ABA claims. None of the "claims specialist" are helpful and very few know anything at all about ABA. All they do is read me the erroneous and obtuse denial code on the EOB. Lastly, the BCBAs that review service plans and sloppy and have little to no attention to detail. They routine kick back plans for missing info, but if they actually read the service plans they would see that all the info requested was presented in the service plan. –Navy, California

We SHOULD NOT have to fill out a pddbi assessment to try to continue to get services for our child! The test was not designed to be used in such a way and it is hard to see a child’s progress, some children do not progress or stay the same and that should not affect their ability to receive services!! The children need RBT and BCBA support in all schools! this needs to be a covered service! It affects the soldiers readiness when his family cannot receive the care that they need! –Army, Arizona

Due to not allowing RBT's in the schools anymore, my son lost a spot at his school and has regressed tremendously and has become aggressive and has increased behaviors that we had not seen since before we started ABA many years ago. His routine has been completely negatively affected by these changes and my service member husband's mental health has declined by watching his son regress and there's nothing we can do to help it get better. It affects our entire family in a negative way and we fear for my sons future. –Army, Florida

The changes in the DHA policies have been egregious and I have a list of problems I encountered as a result. The most disturbing aspect is that the DHA doesn't respond to me and my tricare grievances have gone no where. I shouldn't have to go to my congressmen to get medically necessary help for my kids. My kids behaviors have regressed and ABA can not help with needed things that they used to be able to help with. My understanding is that ABA is only able to help with social communication and social interactions but not in a social setting, which makes no sense. They are setting things up for failure. Also with families with multiple kids with ABA, they do not address the fact that as a parent I can't be in 3 rooms at once to perform parent goals for the much needed self help skills. They are also actively discriminating against those with ASD by requiring the DSMV checklist. No other diagnosis I have requires a form to get medically necessary care. Also the PSI needs to go. It is an unlawful search and seizure as it does screen for abuse and neglect. I have not committed a crime by birthing 3 children with autism. If they want those honest responses they can issue me a warrant as that is my right by the 4th amendment of the constitution. We have been getting ABA for 8 years and it has been so beneficial for my children. It is a travesty that they are creating so many unnecessary obstacles. –Navy, California

This does not support families with autism and especially families which are greatly reliant on the help aba therapy provides. –Marines California

I do not think that it is appropriate for tricare to be asking about how my child's autism is affecting my intimate relationship with my husband or if I like my child. –Navy, California

This process has made it so messy and nearly impossible for aba. This isn't fair to the child or children going through this. They wouldn't make any other person have to jump through hoops and they certainly shouldn't make someone disabled. –Army, Texas

What is allowed to be worked on with our child is significantly impacted by all the changes from Tricare. The therapists aren't able to help the whole child. There are so many things that could be worked on by the therapists through ABA therapy that they aren't able to do because tricare limits what they can bill. These ABA therapists know how to work with our children and can get the most effort from them. They need to be able to focus on all areas of deficits that the Autism diagnosis affects. –National Guard Virginia

Services for our members are extremely difficult to obtain. Therefore, support to the individuals in our community a difficult. As a grandparent, FORCED to care for my grandson, as a direct result of his mothers refusal to care or help in anyway. Services are EXTREMELY IMPORTANT to our ability to care for him. Parents already have to fight every day to care for our children, we should not also have to fight for ADEQUATE services. –Veteran North Carolina

Reducing services for a kid with ABA is very stress for the family and has a huge impact on the child's progress. It becomes a domino effect, the child gets less services, regresses on his behavior improvement, caregiver who takes child to therapy has now less hours available to work, reducing their money intake now causing financial stress that rollovers into impacting the marriage of the military service member. It truly has been a nightmare having a reduction in services beyond what the naked eye sees. –Marines North Carolina

Our children and staff that support them deserve more. Clinic and home based ABA are great resources when A child is under the age of five but as soon as they are required to transition to kindergarten or the school setting there's such a intense need for providers in that setting so that students can work on generalization skills that have been learned and the one on one session to the school environment and out in the community. I teach special Ed , in graduate school to hopefully one day become a bcba and a parent of a autistic individual that utilizes services and there are so many skills that can be mastered within the one on one controlled environment but still need so much support out in the Community including schools. –Marines North Carolina

The withdrawal if service time at such a rapid rate was very difficult to adjust and comprehend. Goals had not been met, but time was decreased. The changes have made it impossible to get services for the areas that had goals. –Coast Guard, North Carolina

Changing the treatment plan goals to not support daily living skills such as: potty training has made a huge stress in our lives and the child with Autism. –Navy, Washington

Please open up telemedicine for ABA services. This needs to be a possibility given changes in the world that have occurred as a result of COVID19. –Navy, California

When the changes went into affect my son lost all community support which means he can no longer participate in anything group wise. It's absolutely ridiculous that they don't see this as evidence based! Being unable to generalize is an autistic symptom. Tricare expects my son to spend 40hrs a day in our house as a shut in just so he can receive therapy now? What on earth is tricare doing!? –Marines California

There are things that my son was learning in ABA to help him now and later in life that this change has taken away. Going over organizational and hygiene skills in ABA was a HUGE help, and now those things are gone. I can only do so much as a parent. Me going over these skills at home only go so far because my child looks at it as me being a mom and nagging. Going over these skills with his ABA therapist and in a group setting with his peers hits closer to home than I ever could. The changes made were not all for our children's benefit but rather made to their detriment. –Navy, Washington

There are too many hurdles and hoops to jump through to ensure my child is able to continue receiving aba. Why is it that only parents of autistic children required to have a parent stress index done? I feel every efmp family should be made to do the survey and not just single out families with autistic children. Also, it is almost impossible to get these assessments done on time because there is not a provider available to give them. Why can’t these assessments be mailed or emailed to parents? –Army, Kentucky

The expectation that all therapy to be in the home or at a center is leading to kids only being able to function in those areas. Don't we all wish autism only happened at home..... Not being able to take my child out in public is limiting our family greatly. The longer we do not actually work on those goals means he will end up needing to be at home incare facility for the rest of his life which in reality will cost insurance more. –Air Force, Utah

ABA services covered by Tricare need to be expanded. Too many families are sent to bases without adequate services. ABA and other therapies are very important for autistic children. –Air Force, North Dakota

Child can't experience regular peer interactions because preschools and community are no longer covered. Can't work on life challenges such as store, beach, park, or preparing for kindergarten! She has picked up other bad behaviors by only being around other spectrum children in clinic or being isolated at home. –Marines North Carolina

Not only hasc Tricare made it difficult to find providers, the ones that have tried to stay with us and opting to discontinue coverage for Tricare patients because Tricare has made it impossible. –Marines Louisiana

Our ABA therapist dropped Tricare due to the changes. We have been with them for over 5 years. Tricare has made it too hard for ABA services to jump through all the hoops, much more than other insurances. I know of 4 centers who have dropped Tricare due to the changes.

To top it off, Tricare requiring my child be "re-diagnosed" every 2 years by a psych is unreasonable. 1. Autism doesn't go away, it is a brain difference. 2. There are a limited amount of psychs, so the waiting lists are long. 3. It is harmful to the child mentally, to go through the testing over and over.

When Tricare made all the changes to the Autism program, I was and still am, disgusted by what it has done to military families with Autism. –Air Force, Colorado

More doctors should be aware of how to help beneficiaries get referrals approved and how to help families with new diagnoses start the process of how to get families enrolled into efmp echo. –Army, Tennessee

How sad it is that we have delay in services because of everything. My son also needs help with going out in public. I'm very active in learning what's best for my soon and hands on experiences help me and my son out which we don't get anymore. –Army, Tennessee

ABA is very beneficial to us and I hope tricare continues to cover it. –Air Force, North Carolina

This new policy has created more obstacles for both of my children receiving ABA by causing hassles with paperwork required. –Navy, Florida

The changes in ABA have resulted in more stress for our whole family. The way that this program is being run is causing providers to no longer be able to work with the military families that desperately need their support. And lack of payment is causing gaps in service for children that desperately need a steady schedule in order to make improvements in their life skills. –Navy, California

No other insurance company, which is what you are Tricare, creates as much chaos in the lives of families affected by ASD as you do. Your parent surveys are pointless. You don't take any of the other stressors of being a military family into consideration. Most spouses are depressed in general, add in a special needs kid without access to services, what do you get? A spouse that's still depressed. Parent training is easier with a professional to guide you. My kid shouldn't have to be diagnosed multiple times for a lifetime diagnosis. That's a waste of time for doctors, not to mention money. And how the hell do you not reimburse your providers but you’re so quick to take their money. Are you purposely trying to make these people pull out of tricare so you can cancel the program? Bet you are. The consequences will not be great for the patients and for the program. I feel like your BCBAs on staff violate their ethics code as well, because no other BCBA in the field (providing services not trying to limit services like your staff does) goes above and beyond to try to limit services. Paperwork is what BCBAs are doing, endless mounds of freaking paperwork to word things correctly to fit the narrative you want. It’s bull. Fix it. –Air Force, New Mexico

My child doesn't cause anxiety. Tricare does. –Air Force, Washington

3 children with autism, the changes are detrimental to our family and ability to provide for our family. With little to no guidance or empathy from tricare. –Veteran Washington

What a slap in the face to service members and their families. Doing all they can do and families get treated this way. Tricare knows what it's doing. These changes have put so much stress on families of autistic individuals. I had to camp out on base for the must for things to get to where we are today. Tricare basically making decisions on someone's medical needs & difficult for providers to provide these services. So difficult they no longer want to work with tricare & its families enrolled. Putting families in a rough spot. Being told by current ABA provider that it's usual for tricare to deny 3 times before they approve. I can't even remember how many times the provider had to email new assessments because tricare asked for more information. I had to resign & go over them every time. Things being included in my child's assessment about MY(I'm his mother) mental health. Everything is a train wreck & tricare needs to fix this before autistic individuals get to far behind. –Navy, South Carolina

My son goes to private school and has no other resources available to him. Even if we go to Public school he'll have minimal support. My only option is to take him out of school to receive ABA services. Services need to be offered in the school setting again so that I'm not having to pick between his education and his mental health. They are both necessary for his overall health. –Veteran Tennessee

The Vineland III used to be required every two years, now it's annually. That, on top of filling out a survey every six months that feels like I'm being asked to prove my son's life-long disability twice a year, along with a some-what invasive parent survey that takes nothing about parent background into consideration (Example: I'm a sped teacher w/self-contained experience. Holding my minimal stress levels with my "high functioning" asd kid and giving it the same weight as a first time mom with no special needs experience but high stress levels, no matter the "functionality" of her child seems silly.) seems like pointless hoops for already busy and stressed parents. I love data like no one else, but decisions should be made off of viable data, and this isn't it. –Army, Kansas

Obtaining ABA & the requirements mandated has made it difficult for our child in ABA. Especially the 2 year evaluation. Autism doesn't change & why decrease care once the beneficiaries are

Improving? Makes no sense. Nor does the parent stress questionnaire. –Army, Tennessee

This has made life extremely stressful. –Air Force, North Dakota

We have to make even more sacrifices now that tricare has reduced the amount of options available for my son with autism. He absolutely needs ABA therapy in school and at home. I can't work full time and somehow take him to a clinic for the 30 hours of therapy he needs per week. –Marines Indiana

Tricare and EFMP have been no help. We waiting for services for my son for 2 years and then when he is finally getting ABA they decide to change it and tricare had the nerve to tell me he needs a full evaluation again because it's been 2 years and his autism may just go away. It doesn't work like that. Now my son is struggling with safety issues and lifestyles and severe regression because of tricare changes. This is unacceptable. How are military members suppose to deploy and protect the country when their families aren't being protected. People are leaving service early to get civilian insurance just to cover their children. I was also told to enroll in ECHO but yet no one can even tell us what that covers and what it is. Get it together tricare. –Air Force, Utah

The limitations of what can be done during ABA such as life skills is super detrimental to the patient. –Air Force, Arizona

We need to have access to other forms of therapy for our children. DIR, music and art therapy, MeRT therapy, hyperbaric oxygen therapy. You are making ABA incredibly hard to get, please make other therapies have coverage. –Air Force, Arizona

The changes to the ABA process has made it more difficult for my child to get services. He was getting services in school which is where he needs the assistance (in a real life setting). Now we are forced to send him to ABA clinic after school. Instead of him being able to be a child after school and spend time with family like he was able to do before he now has an even more exhausting and hectic schedule. We just went through the process to get an authorization to get center therapy and I can't believe Tricare wastes their money. There are so many unnecessary steps that are taken now for my child to get ABA. Being a cat 5 child the doctor should be able to submit a referral and you approve it. Now the doctors office and us as parents are having to jump through so many hoops. Not to mention funding an ABA center that takes Tricare is so hard because of the stipulations you put on them. Most ABA centers have a 1 year or more wait list. When you have a kid with severe autism they can't have a year lapse in services. –Navy, Mississippi

If my child could have support in the school then he would be thriving more and the school itself would be able to put themselves in other places needed. But because of lack of in the school teachers are being pulled to help with my sons challenging behaviors. –Marines Georgia

Tricare is failing our autistic kids and service members. Our children need more life skills and educational assistance. What you have done is a shame to special needs families and made our life even more stressful. –Coast Guard, Virginia

The defense healthcare policy changes to the autism care demonstration program have deeply impacted our family, along with many others. Our children are being discriminated against and isolated in clinics as opposed to receiving support where they need it the most (in the community, in school). Tricare is failing our children.

My child greatly needs the additional support in school! With the additional support, he was able to participate in general education with peers as opposed to remaining restricted to a self contained class. He is now no longer able to participate in General Ed, leaving him restricted to a classroom where he is no longer able to flourish behaviorally or academically. He is now showing multiple behaviors of regression. His anxiety is so overwhelming that he cannot walk into a room, listen to a person talk, hear his sister giggle without covering his ears and cowering. He is also now trying to elope from his educators (a behavior that was almost completely eliminated when he had the additional support).

His daily living skills have also taken a huge negative impact. He is more impulsive (due to his anxiety/inability to communicate/day to day struggles with being out of the community; he lives between home-school-clinic now).

These changes have only increased the isolation that our families are already experiencing with an autism diagnosis. Because of the changes there are so many limitations on how many hours he can take advantage of throughout the week between school and therapy. When he was able to get the services in school and in the community, we were able to accommodate his recommended 40 hours a week. We are now down to 6.

As his parent/full time caretaker... my life has also been drastically impacted. I'm overwhelmed, often depressed, and I have had to give up my career to focus solely on his needs And accommodating him in anyway possible without my own additional support from BCBAs and RBTs who can offer guidance when it comes to certain behaviors.

We are being isolated and discriminated against. –Coast Guard,

Please bring back the option for telehealth and aba services. Some of us have medically fragile children and do not feel comfortable having strangers in our house for therapy during a pandemic. –Navy, California

This is a Class A Disaster for our families. Tricare HQ rep I spoke with was dismissive, told me to speak to my congressman and kept telling me the requirements (e.g. parent stress index) was outline in Title 10 and the NDAA. I've never heard even one time from my care coordinator. Our ABA company discharged all Tricare patients and now we wait for a new company...if there is one. Meanwhile, my daughter is regressing. –Veteran Virginia

We have never been able to get ABA services. Been diagnosed for 6 years. No service providers in our area. Lost our care manager when they switched from United to health net. So we drive 3 hours to see a neurologist once or twice a year just for pharmaceuticals, no therapy available. –Air Force, District of Columbia

Some of the services that were provided during the ABA sessions are no longer authorized and has caused an unnecessary strain on our family. We have had to go out and pay for alternative assistance which is causing a financial strain to the family. –Navy, Virginia

Changing what is daily life skills that used to be covered like potty training or outings but not allowing or saying it's not needed is a disservice to any child with those struggles. They are part of daily living and should have stayed in the program. Many families who need assistance in those areas are being left behind because of what tricare considers a child /Adult with autism needs. The providers and parents know the child best and know what things to work on because they see that client everyday where tricare doesn't. Something to think about and improve. –Navy, Maryland

We just started ABA and I am unfamiliar with what the changes are to the program. While we don't anticipate it affecting the service member negatively, as the mother I feel as though my plans for working are unlikely to happen due to the elevated needs of our autistic child. –Navy, Texas

The amount of problems our family has faced since 10/2021 to continue ABA services for our son has been ridiculous. I find it completely unnecessary for my child to have to go through an assessment AGAIN to prove to tricare that he is still on the autism spectrum considering this is a LIFELONG DIAGNOSIS. We had a 4 month lapse in services due to all of the new additional requirements that prevented the authorization to be processed after my son has been in ABA therapy for 4 consistent years. Please make some changes to the authorization process, the recent changes have made it discouraging and incredibly hard for families to get the therapy services that truly help children on the spectrum. –Navy, Virginia

Disappointed in changes to ABA coverage. Creating barriers to care for our children only intensifies stress in our lives and builds uncertainty in a culture that already has stress and uncertainty. They have shown us that they are not in the business of providing appropriate care for our families, their goal is to save a dollar at the cost of our children who need it the most. TRICARE does not care about our families. They certainly do not care about our families with autism. –Army, South Carolina

TRICARE stopped coverage for my son's ABA program. We had to decrease his services and still incurred over $7,000 for the services we continued, and will pay another $2,000 before the end of the school year. Additionally, we have paid an extra $400 a month for other health insurance (the $9,000 we will pay for service represents our co-pay/catastrophic cap with the other insurance). So overall, the loss of coverage services cost us $13,000. The financial stress has been indescribable - we are a two income family but we have gone into significant debt. Change is very hard for children on the spectrum. For us, the monetary cost to our family, the impact on my health my health (I suffer from depression, anxiety, and heart issues that have all increased with this), and the increase in out general stress is less important than our son's future. We were not willing to throw away all of the progress he had made through the services he was receiving just because the DHA made changes that devalued him. To them he is just another cost, but to us he is a person who has value and, given the right tools and opportunities, has a a bright future ahead of him. –Air Force, Florida

The forms now required to receive ABA have an overwhelmingly and UNNECESSARY negative slant to both questions and answers. Additionally, they're not even considered clinically relevant by reputable BCBAs. It's just an added paperwork barrier and an added delay to my dependent receiving necessary and appropriate medical care. –Veteran California

Since being diagnosed my son was told that he needed ABA therapy, we are put in the echo program and give in a case manager who never actually communicated with us never reached out at any time. And it's been over a year. Then I get a phone call because of my referral is not there and they just want to send me the same stuff and same information that EM and can provide me here with no assistant hardly ever. In that case as well that we've been denied by an ABA location setting the day after having a medical diagnosis of autism did not see my son is autistic. Also having issues here at the school on post stating almost similar situation and not properly handling my EFMP IEP or BIP information correctly. I have had to take matters into my own hands where I have had to take financial struggles Upon my family which has been causing a lot of issues as well as the way that the policies in addition to other areas or causing more harm than good on my autistic family and child or behaviors worsened because of other policies that impact this one as well. My child is not receiving services whatsoever and why is that he needs to help with his emotional impairment nor am I able to find ones for home which is why I was told I really needed to the lack of employees and availability. I was told that I had to basically choose education versus his ABA services if I ever wanted to find one for him. I find that ridiculous and I find that there's not a service for my child who needs help with socialization in other areas for emotional impact because my son is in school. And there is no ABA services here on post or authorized to come into the school which puts me in huge limitations. And my son is already has education hindered due to the issues at the DODEA schools. –Army, Georgia

The 2021 ACD changes have been horrible for my son and family. With less than a months notice Tricare sprang these changes on us and has caused significant emotional stress for my family by eliminating his in school and community services and reducing his at home services to a few hours a week.

My 6 year old son **** was non-verbal since he was 15 months old and diagnosed with Autism Spectrum Disorder when he was 2 years old. We PCS’d to the Washington, D.C. area the summer of 2019, found an incredible ABA provider, and enrolled **** in a private school that would allow his Behavior Therapist (BT) or RBT in the classroom with him for 1 on 1 ABA services to help him interact with his peers and learn how to function in a classroom environment. He was making good progress when the pandemic hit. During that time we were fortunate to continue ABA services at home and **** was able to find his words and start speaking.

His speech delay still puts significant roadblocks in front of him that he strives to over come. He has difficulty communicating, following class directions and engaging with his peers. Despite these challenges he was thriving in a typically developing classroom with the assistance of his ABA RBT. He was making amazing progress having full time support to facilitate his social engagement with his peers and understanding the complex asks of his teachers when ACD made the horrible mistake of robbing kids like **** from these critical services.

We worried and agonized over what this means for him in the future if he doesn't have the early intervention ABA services provide that give him the tools to be the best version of himself that he can be. We have seen a significant backslide in his social and educational progression. Negative and disruptive behaviors that his RBT had protocols to curb and eliminate have accelerated and detract from his learning. I have had to leave work several times and turn down TDY opportunities because I need to be available to help him in the classroom or meet with his teachers and staff for how they can best help him or address behavioral issues.

We had to hire and educational aide and paid several thousand dollars out of pocket to be with **** full time to make up for the void the loss of ABA services has caused. It is essentially a bandaid and we are unsure what the long term consequences will be. I am fortunate to have some savings to be able to pay for an aide but how many other service members can't afford one and their children will suffer as a result. There are approximately 137,000 dependents enrolled in EFMP. With 1 in 88 military children being diagnosed with Autism, these changes have the potential of affecting the readiness of the force.

Please give our children back these critical services they desperately need to be the best versions of themselves.

–Coast Guard, Virginia

Our autistic child as well as our entire family have experienced a decline in our quality of life since the 2021 ACD changes. My son has regressed in skills at home as well as in the community. His self-injurious behavior and aggression against others has increased. We cannot safely leave our home and do not have the support of our therapy team to help us improve our current challenges in the community. As his parents, our stress levels have increased as we are now solely responsible for attempting to teach life skills (without success), and we are concerned for our child's ability to have independence as an adult. Our family is more isolated than ever, and our mental health is poor. –Army, Texas

The ACD has made it harder to get approvals for essential needs for my son. Instead of it taking 7-10 days, we are now waiting weeks for Tricare to approve. We lost a provider in the area because of their lack of integrity and fraudulent billing. I now have a provider driving daily from an hour away to provide in home services. I had to navigate this on my own. It is stressful switching providers and all of the paper work required as well as the weeks waiting for approval and the time off that my son was not receiving services between providers. I am happy that Tricare dropped the provider, but the transition could have been smoother. I wish that there was a local team on base more available to help. EFMP is stretched thin and only provided a typed list of resources. I would have preferred a more one on one personal approach. –Air Force, Wyoming

Separating ABA from education has placed undue hardships on families. We can spend only so many hours and spend only so much money to address the gaps that the education system has left our military and special needs children to deal with. Schools have no incentive to assist military families. They wait for us to leave, they drag out processes, they make every step excruciatingly painful with half truths and intentional misleading. So many cards are already stacked against the successes of our children as they frequently move and change medical providers, insurance, schools, homes etc. In addition not being able to access our children's medical records online after they turn 13 adds another barrier to proper medical care. –Army, Texas

My daughter was falsely enrolled in tricare west as a new patient in reference to autism services. This was because we moved from east to west and we requested records to be moved and they didn't do that. Because of this we had to provide a lot of testing that we shouldn't have. My daughter finally started services in the west and two months into it ,(February 28th),started requesting more testing and she wasn't able to return to aba until we provided the adi-r. We provided this on March 14th and my daughter is still not back in aba services. When we sent tricare west the adi-r we were informed they didn't have any record of **** having been in the aba system for tricare west. We were literally told a different reason as to why she couldn't start back all dealing with referrals and something about hearing from a navigator. Long story short. Turns out we don't qualify for the and, asn stuff because we're not new to autism. Now I don't know what we're waiting for to get my daughter back in services but throughout this process I was told by 3 separate tricare west reps that they do not understand the changes the dha made and therefore they do not know what they are doing. I was told by, ***********, the autism care demonstration lady that had to contact every single family in need of aba in the western region to assign families an ASN before they can start receiving services is literally THE ONLY PERSON doing that job. I was told that by a tricare representative and by ******** herself. In fact they are going to "get another person soon" and I'm not sure that one more person would be even close to enough. I understand that my family doesn't qualify for these services thank God.. but my daughter has not been receiving services because they thought she was supposed to. Within this time she has regressed behaviorally from goals we had achieved. Having her routine ripped out from under her has caused anxiety and in turn destructive behavior. We threw out a couch, a mattress and have been to the e.r. once. My husband has been considering early separation because she's not getting help. He has had to come home to help me almost every day for the past week and been to a counselor. I filed several complaints with dha, wrote senator twice, contacted autism society of el paso, efmp, and echo. My daughter has been without services since February 28th and it has caused so much mental and physical damage in such a short time. She wasn't even supposed to be receiving those services but that was her Aba providers mistake that I am beyond thankful they made because I can't imagine the damage that would have been done in 4 months and counting. The dha changes are completely unnecessary in my opinion. My daughter was receiving every service she has needed without a navigator and so I don't see the point in causing destruction and revoking services from anyone to implement unnecessary changes. Especially since they only have one ACD that has to contact an entire region of clients before they can even receive an asn and meet their list of demands and finally finally receive services. This is harming my family mentally, physically, and financially and I'll be glad to provide proof –Army, Arizona

Due to all of the restrictions more and more ABA providers are choosing to not work with Tricare. So the experiences (seasoned Behavior Analyst) are not working with our children. Leading us to work with new BCBA who do not have the experience to work with my child and my complex highly stressful situation.

I want quality care services. But the ones that are taking in Tricare there is a lack of supervision and they are not updating programs for services, because Tricare does not cover that. But Medicaid does cover those cpts. –Air Force, Maryland

I'm worried my provider won't be able to continue jumping through all of the hoops and submitting so much information just to get an authorization approved. There is a trickle down effect on how they have to also inform staff of all of the changes and it impacts training and is inconsistent with how they are providing care to other clients. I'm grateful, but I'm not sure how much longer they can or should keep accepting TriCare. –Air Force, Colorado

The changes that were made have affected my daughter negatively. The places she needs help and struggles in are no longer allowed. She needs help in her school and she can no longer get it because tricare won't allow rbt's in the school any longer: my daughters school doesn't have the fund or people to help, even if tricare thinks it's up to the school. So now I have to make new educational plans because of it. I'm pulling her from public school and now homeschooling her. –Veteran Washington

We fear providers are going to drop out of Tricare which ends up with less providers. –Navy, Virginia

Prior to the recent changes, the ACD was already overly restrictive and difficult for families and providers to work with, such that it was very difficult to access care (behavior analysis) b/c many providers refused to participate with Tricare. The recent changes have made the ACD even worse. Every provider we call can’t work with us b/c they are not taking new Tricare cases specifically because of the recent changes. They complain of being overburdened, underpaid, et c. It is clear that DHA/Tricare did not consult families or providers in designing the ACD, neither past nor present iterations. It is clear that the goal of the ACD is not to help military families but, rather, to pinch pennies by preventing people from accessing care. –Veteran South Carolina

They don't pay for services being rendered. They haven't consistently paid since August 2021. –Navy, Florida

Children receiving ABA services often have other conditions that require therapies and/or treatments. Adding unnecessary dr appointments to "verify" a condition that they have already been diagnosed with is a misuse of the doctors time as well as an additional burden to the parents and child. –Veteran Texas

The changes have been more then we could've ever anticipated. It was already hard enough to obtain services and these changes have made it even 10xs harder not only for parents but our physicians who love our children and are trying to help. It's been an absolute nightmare & it should never be this hard. Service members & their families have enough stress as is and this is just a complete disregard to their feeling and times. Do better. –Army, Colorado

Changes to TriCare programs for autism services have had a dramatic impact on our family. It has been a struggle to get services started after an assignment transfer and sustained with the same level of support. Plus, their cumbersome requirements have added stress to me and my wife, because we are having to balance two work schedules against our dependent's multiple, needed therapy sessions to complete bureaucratic TriCare requirements. –Air Force, Nebraska

I LOVE THE CHANGES Tricare made to the autism demonstration. No where in the changes does it say that your child can receive life-skill assistance - all the BCBA needs to do is explain how it would benefit the child, and name specific places and how long in those places. I think parents are 'angry' because they finally got caught for abusing the system (i.e using the BCBA as a babysitter on public outings vice actually working on life skills like walking through a grocery store and NOT shopping, going to a zoo and not leaving the child off with the BCBA). Our BCBA requested for us to go on outings like the playground by our house, to walk through our neighborhood walmart and learn to WALK vice riding in a stroller or shopping cart - and we got approved, because our BCBA is HONEST and we do what we requested which is to practice those life skills. Being a parent to autism, it's a LIFESTYLE, not just a few hours a day 'thing'. I think parents don't see the results of ABA because they expect the BCBA to do it all and be the magic pill vice implementing what has been taught during parent training. I love ABA. I love our BCBA. The changes tricare made does not affect me - and I have two kids, under 5 on the autism spectrum. We have seen such AMAZING and positive results from ABA. My 3 year old, in 5 weeks of ABA, after returning from living overseas, is now potty trained, eats with utensils, rides on a school bus to and from school with out an attendant. After 6 months of ABA, our 3 year old can now play at a playground (supervised of course) that doesn't have a fence; he can eat a variety of foods, he no longer has ANY safety issues (i.e head tapping, spinning, oral sensory (pica) etc.). Our son can also DRESS himself, and sleeps through the night without having potty accidents. ABA has helped bring out the very best in our son, and give him confidence. Our 22 month old was recently diagnosed with Autism, but our therapist was unofficially working with him. He now HEARS his name after 4 weeks, and is using utensils to eat. He also 'sees' children now, and wants to try and socialize. ABA is a blessing - if parents utilize and follow to it the way it was intended, and stop seeing it as a magic pill that doesn't require their involvement too. –Navy, Virginia

It has been extremely difficult to get answers from the autism care team. My ABA providers have not been able to get complete approval for all of my son's services due to the extreme lack of communication and lack of attention to paperwork previously provided. I just want them to DO THEIR JOB. Not ignore my family. My son is not getting the care he needs because of the inefficiency of the TriCare Comprehensive Autism Care Demonstration Program. –Air Force, Iowa

Our beneficiary insurance should MATCH CIVILIAN STANDARDS AND BE ABOVE IT.

You CANNOT have an #allvolunteer force with crappy subpar care and services. You cannot imagine the stress and anguish of leaving your "special child" with an unqualified neighbor because your duty requires it. We will NOT HAVE the right talent in our military and will NOT be able to protect our future and freedom. –Navy, California

Tricare's changes have led to fewer providers and significant barriers to families accessing much needed care. Tricare also no longer allows ABA providers to directly target language skills, which is a core deficit of children on the autism spectrum. How and why this change was justified is beyond me. Children must be able to communicate with those around them in order to get their needs and wants met. This decision must have been made to save money, as it can be a lengthy process and is only to the detriment of families and the children they are supposed to serve. Not allowing ABA providers to teach language is absolutely harmful to the children they are supposed to serve. These changes should be reversed. It took our family many hours and days to make sure all the requirements were met and we were lucky that our doctors were able to understand what was required and we did not receive a break in services. Most people do not have the ability or time to meet the arbitrary requirements Tricare has put in place. –Navy, Hawaii

Please, stop making things more difficult for us! We have enough to worry about and enough battles to fight! Our kids and young adults deserve better. Our families deserve better. We already sacrifice so much...Thank you –Army, North Carolina

In addition, DHA has been disregarding their responsibility in staffing the Family Practice clinics at the MTFs. My EFMP child was forced out to the network to a new network provider with NO notification to us about this change. We found out after requesting a medication refill prior to my deployment. Furthermore, his new pediatrician is unfamiliar with the EFMP paperwork for repeating his status and now we are facing additional challenges in getting them to complete these forms. They are also trying to charge us per form (out of pocket). When you tell me DHA cares about their beneficiaries, I and my family are an example of how they have NOT cared about the only people they are responsible for: their beneficiaries! –Navy, California

It took a month of back and forth between my child's PCM, ABA provider, and Tricare to finally get everything Tricare required. It was always one more thing Tricare required, one more step, one more barrier to services. My daughter, who had been going to ABA religiously for two years, was out for a month and there was a noticeable difference in detrimental behavior. –Veteran Iowa

This impact has made it extremely difficult to receive any services for my son, outside of school. My stress levels have increased because I’m not sure I will be able to work due to my son no longer having any sort of supports outside of school since he will need me to be with him. Daycare is not an option due to him being kicked out and it not being high enough support. –Air Force, Utah

Too long of a waiting list for ABA/RBT on Oahu!! –Navy, Texas

These changes only make it harder for our children to obtain quality, consistent ABA services. My son is on week 2 of no services because of these changes. We face enough challenges as military family's. We should NOT have to fight this hard for services for our children! –Army, Hawaii

I would say that the changes to Tricare regarding services available to persons affected with autism is borderline neglect. I now have to call Tricare every time we're renewing our authorizations due to requirements by Tricare for justifying the services for my child. The bcbas Tricare is higher to review the authorizations have never met my child and could never understand his needs and how we put his care plan into practice. These changes to our policy has also led a lot of ABA providers to stop taking Tricare so now my family have to consider taking our son off of Tricare to continue his ABA services. Just this year we requested a medical swing for my autistic child and was denied due to that being recreational equipment despite the fact that there is scientific research supporting that people on the spectrum desperately need sensory input to process experiences they have throughout the day. I could not believe that because my child is not a paraplegic that they are not given the medical equipment that they need to deal with their disability. Again I fully think this has to do with the insurance company trying to save money as well as trying to hire bcbas to support the company in such a way that they can save money. These bcbas that Tricare has hired now question everything that my company is doing in person with my son. It has caused so much anxiety stress and depression that my son can't get the help that he needs on a regular consistent basis. There is more to say on the topic but this is a survey. I truly believe that the changes made to our healthcare in 2021 has been detrimental to the service of children with autism covered by military insurance and that those changes should be amended and undone or adjusted to be actually helpful. –Navy, Washington

THE PROCESS TO CONTINUE SERVICES IS SLOW, RESULTING IN A GAP OF ABA, WHICH DIRECTLY IMPACTS MY CHILD ON THE SPECTRUM. THERE IS NO CURE FOR ASD SO CONSIDERING REDUCING HOURS AS CHILDREN GET OLDER ONLY MEANS THEY FACE NEW CHALLENGES WITH LESS SUPPORT. AUTISM IS A SPECTRUM AND DENYING SPECIFIC TREATMENTS IS DISHEARTENING AND A HARDSHIP. TRICARE IS DENYING MANY DIFFERENT SKILLS THAT PROFESSIONALS CAN ASSIST WITH. MANY OTHER CLINICS AND PROVIDERS NO LONGER ACCEPT TRICARE BECAUSE OF THE DIFFICULTY IN PROVIDING EFFECTIVE SERVICES THAT TRICARE AGREES WITH. –Veteran Hawaii

There is absolutely no reason that a parent stress survey should be a requirement for my child to receive necessary behavioral health care. No other health insurance requires that type of intrusive and inappropriate screening, nor does my stress level have anything to do with the needs that my child has for appropriate aba. It is not remotely part of a standard of practice. The lack of providers who take Tricare due to the DHAs inability to have a functioning program decreases our access to care. ABA providers do not want to take Tricare because it is so difficult to work with the insurance and every layer of bureaucracy decreases the amount of providers who want to work with our families which continues to decrease access. Additionally active Guard and Reserve members do not have the support of any efmp or Tricare resources due to their typical locations not being collocated at an active installation. This makes it even less likely that there will be the appropriate number of providers in a region, even if the region is a major metropolitan area with an adequate number of providers, they are just not providers that either take Tricare or where there is an understanding of the need for active military members to have providers (such as Des Moines, Kansa City, Madison, Milwaukee.etc). –Air Force, Iowa

The changes have made renew referrals extremely difficult. There is a lot of miscommunication. Aba is having to cut down on things that benefited my children because tricare deemed it not helpful. Our ABA provider has to jump through hoops to get referrals renewed because tricare has made it increasingly difficult for all parties. –Navy, Washington

The long delays in approvals for services my child has been receiving for years have caused long gaps where he is not able to attend ABA therapy because tricare will not back date while they get their stuff together. This has caused missed work days and missing pay for my spouse. A lot of unnecessary stress and worry. Even worried about reporting that we have an exceptional family member due to the flag it puts on service members. –Navy, Illinois

As a parent and military spouse, I find it disrespectful that Tricare would choose to decrease services that are beneficial to the special needs children of our service members. Our families already have a lot of stress placed upon us, and we make many sacrifices for this country. In addition to that, military families go through so many changes and transitions, that choosing to decrease ABA services for children with Autism--those who already have difficulty with change--is such a disservice to these kids and their families. I don't mean to sound ungrateful, because Tricare has provided us with many other healthcare opportunities for which our family is thankful. But I believe ABA and other services that serve special needs children are areas where Tricare needs to reassess their decision and consider how much it has benefited so many military kids. –Army, North Carolina

There is a huge disconnect with communication between Tricare/Congress, providers, and families. I have no idea what is going on and half the time what the provider tells me first winds up not being accurate. It is infuriating that families aren't assigned some kind of case manager/point of contact to facilitate communication. As my child's mother, I'm having to serve as case manager and it's extremely difficult getting accurate information from Tricare/Congress about changes and what information is needed to continue receiving service. –Veteran Virginia

As a result of the 2021 Defense Heath Agency policy changes obtaining and keeping services for our son has become exponentially more challenging. Many of the community outings/activities that we were working on to help our son be able to engage in society were taken away and we have spent months trying to get these locations approved again. His ability to manage his autism & anxiety out in the community has decreased and caused more issues for our family out in the community. The requirements for more parent meetings & documentation has made my & my husbands schedules significantly more challenging. As a result we are looking into other career options and are fearful to move out of the area because we don't know if anyone else will be willing to work with TRICARE or have too long of a waitlist –Coast Guard, Virginia

ABA is pointless without being able to help the child with Daily Life Skills. And Tricare wants more of an already burnt-out Parent/Caregiver to do the therapies themselves and essentially become and RBT. All because Tricare wants to save a $1 or get rid of the Autism Care Demonstration program all together. And seriously there is no need to do a 6 month parents stress test. Its a no brainer a military parent with a special needs child is already stressed to the max. And your limiting the access to care coverage is a joke and it hypocrisy your adding more stress to a family who has an autistic child by doing those parent stress surveys. –Air Force, Illinois

Tricare caused extreme stress due to the policies. I had to remove Tricare and use Medicaid so my daughter could receive treatment. It took almost a year for Tricare to be removed as primary for my daughter's prescriptions. I had multiple grievances filed and was denied needed medication multiple times. My daughter is my dependent and they said I should remove her from my DEERS as a fix and that is not an option. I finally took someone to actually call and verify my daughter was no longer using Tricare for medical. The stress Tricare lays out to both the client and the ABA provider is insane...I have only seen negativity to this system, My daughter does very well with ABA

–Veteran Washington

With the changes to ABA, there was over a month between services we had for the last 1.5 years where we had no normal routine. Said child thrives off ABA and when it was stopped abruptly the amount of regression that ensued was astounding. We have also lost hours due to center being too crowded with clients and lack of staffing issues because they are one of the few that accepts tricare on an island. –Marines Hawaii

ABA approval should be granted with a diagnosing providers referral. All these steps and hoops to jump through cause a significant delay in services and will forever impact our Autistic children because of it. –Army, Washington

Removing the ability to target adaptive skills will decrease independence of my son thus costing tricare more money as he gets older ! It makes no sense that an insurance company would not want a beneficiary to be as independent as possible! Absolutely terrible that my 17 year old is unable to work on adaptive skills . He still isn't fully potty trained! –Navy, Virginia

Removing therapist from schools makes it harder on the teachers who are not trained to help my child. I am noticing and hearing about more hoops and paperwork aba agency are needing to complete and as a result dropping Tricare. Because of this, I, the spouse need to prepare for this possibly and might have to add my child to my work insurance. This creates additional costs to our family and the need to find a provider that might accept both insurances and/or removes the ability to leave my job to provide additional support for my family while my spouse is gone for extended periods of time. –Navy, Virginia

The new changes created lots of confusion for providers leading to a gap in services. The re-diagnosis and PSI portions were difficult to computers due to lack of providers available. Also, the changes pertaining to BCBA supervision and settings have led our team to decide to no longer take new Tricare clients and debating even staying with us because they feel new restrictions are unethical. The changes feel discriminatory and nothing more than a strategic move to make the process so difficult people give up or services are terminated. These changes did not have the beneficiaries in mind at all. –Air Force, Hawaii

These services are absolutely necessary for these children to have success in life. Before this reduction in service the therapists were able to assist the child in behavior modifications generally but more importantly interpersonal interactions in the public sphere. The idea of cutting care in the public is absurd and is the most significant help for the child. Helping them learn how to tolerate others in their space and learning how to enjoy their time with others is so important to their mental growth. It is also be absolutely understood that their daily living care i.e. tooth brushing/dental visits along with bathing, toileting are all important to the long term health of the children and so need to be addressed. Many of these problems can be overcome with the right behavioral approach I know this to be true. My son at 3 yo was not potty trained and would bite pinch and kick for often no reason that we could identify. He had lost his language and was very frustrated all the time. With this help starting at 4 he has now trying to communicate, brushing his teeth and is potty trained. He rides a bus to school and is learning basic skills and we are excited to see him start to blossom. He is learning to use his speech device and hopefully through ABA we will find more ways to reach him. He could be growing faster if the therapists could help us with some of the interpersonal situations. I am not sure what or why the limits but if they can't help him with personal hygiene life skills and they can't go into public with him for those people skills then they have narrowed the field to the point where there is little that can be accomplished effectively. If there are people who are abusing the system then fixing that problem should not be done by reducing benefits to all. I have found that many times the parents new to the system don't understand what is what. Many that are receiving treatment are also receiving or are eligible for respite care through medicaid exemption programs and they need to understand the difference. –Coast Guard, Virginia

Requiring the Vineland, STS and particularly the highly invasive and unnecessary PSI every 6 months is truly excessive and stress -inducing for my family. Both parents work full time, so these tests require that one of us take time off work on multiple occasions, just to complete these assessments. To what end? Ours are done at a military treatment facility and they produced TWO rejections from TRICARE for not being submitted correctly! The ABA providers have no control of administration of these assessments but then they have to fix everything, follow up on the errors and resubmit. A 75+ page report every 6 months is absolutely ridiculous and excessive and an undue hardship on the ABA providers, that takes away excessive time and money when they could be providing care to our kids. These policies are driving providers away from accepting tricare insurance and causing even longer waitlists for the remaining providers that are trying to continue to provide essential therapy! It is unconscionably cruel to maintain all these additional roadblocks to care for our children and is stress-inducing to parents, not stress-reducing in the slightest. –Army, Hawaii

As a result of the changes in the ABA services not to include community setting, it is difficult for us to work on the social, emotional skills in the community setting with peers with an ABA therapist, where my child needs to learn the skills and apply them. –Air Force, Hawaii

The changes have worsened our quality of life and the ability of the ABA therapist to intervene in the most helpful way. Please allow ABA to be practiced as determined by the provider not the insurance. –Army, District of Colombia

The new policies DHA put in place have affected my ability to focus on my work and the overall mission. Many sleepless nights thinking about what I need to do for my child to have continuous treatment through all environments. We saw an increase in behaviors and soon realized we need to do something. Autism is a pre-existing condition, therefore most insurance companies will not cover therapies until after paying for a year. Then we’re faced with deductibles, facing $10,000+ and will soon be in debt if that's the option we take. One night, my spouse suggested taking their life. Her/his life insurance will cover 10 years of therapy and it will be enough to give our child the quality of life they deserve. With the cost of one life, they give another a chance of surviving the life/diagnosis they were given. With tears in my eyes, I said if anyone is going to do it, it will be me. $400,000 will give our child many more years of therapy and more. Joining the military requires sacrifice, I have sacrificed many holidays, birthdays, anniversaries, births, and I would do it all over again, but I will not sacrifice my child’s quality of life. –Air Force, North Carolina

We are extremely frustrated that the changes have decreased the amount of academic skills that can be taught within ABA services. ABA principals and techniques are just as vital for academic skills as they are for social skills. Not allowing ABA providers to work on such skills hinder the child’s ability to gain academic skills to meet or catch up with peers their age. General education teachers do not have the training or credentials to apply such techniques. My son receives 40 hours of ABA each week and is now expected to work on school work an additional 5 hours each week per Tricare being they no longer allow ABA providers to program with it. This has taken a huge toll on me mentally and emotionally and have seen a difference in my son as well. After spending 8 hours of intensive therapy the last thing he wants to do is spend an additional 1 hour each night to work on school work to catch him up. –Navy, Hawaii

Due to the new changes, our ABA provider has had to put services on hold due to not being able to obtain authorization since there are more criteria to meet (assessments, certain documentation/signatures). It's also more stressful having to keep track of these authorizations and due dates for assessments and screenings. –Marines Hawaii

2 re-authorizations in a row, we have had lapse in service due to the new Tricare changes. Recently, after a 2 week lapse, Tricare gave the authorization, but limited 97153 to 2 hours per day. For about a year, our service provider has been unable to fill our hours (12/week) so I called every company within 30 miles with center-based ABA to see if they had better availability. Every single one has stopped taking Tricare. I live in metro Phoenix, so this was shocking to me. They all state that the changing requirements, limitations on care, and strange billing policies were the reason they stopped. –Air Force, Arizona

This has been extremely detrimental to my children and it breaks our families heart!! –Army, Tennessee

Lost our ABA provider. Waited for our name to top the already long list. Now at the bottom or another agencies long list. PCSing soon will have a 2 year gap at least. Will apply for Medicaid and separate from spouse if we can not find a provider who can take Tricare. –Army, Virginia

The changes were made without parent consult or parent notification. We've had over 4 weeks gap in services because we did not have a diagnosis with one of the five tests required (though we've had the diagnosis and received ABA care for 3 years). We've had to take our son out of school days to get him the testing and it is causing behaviors to worsen. Our ABA clinic has told us they will have to wait list and we lose our spot because of this, right now we're sitting at 6 month wait and now more clinics in our area are not taking new tricare patients because of the changes in what they can do. So we no longer have services and have to be on the wait list at our clinic to get a spot back and hope it works with our school schedule. We hope changes are made to continue the promise by the government to provide medical care for our children as We've spent over 12 years moving, making lifestyle changes, and having deployments for this country. We are frustrated in services being taken away and the exodus of providers from the network. –Army, Alabama

Our military members serve and DEFEND! Our country. Why is it that our benefits are decreasing??? We need our kids to have everything they need! No questions asked! Some family member experience there spouses being a "KIA" and there are so many grants and benefits for there families. However, we do the same and they want to cut services for our kids! It's not ok!!!!! Let's take care of our military members and their families the way they deserve! –Air Force, North Carolina

These soldiers put their lives down for the country, the least you could do is to support their family members who need help. –Air Force, Illinois

Please help our kids! It has been a real and overwhelming struggle for both my children, myself and my husband. –Army, North Carolina

Can you imagine if our soldiers could limit their serve locations the way Tricare limits ABA service locations. ABA went from no restrictions to only in home and clinic. No more outings or school settings. Not denying services, just curtailing them. Still getting ABA services through Tricare. Should our soldiers be able to limit their location of service from no restrictions to just stateside assignments. Definitely no overseas or combat environments. Not denying service, just curtailing it. Still getting service for our country. –Army, Unknown Location

They cut several of our daughter's ABA programs, but possibly most upsetting to me was the feeding program. Because apparently, even though eating/feeding difficulties is a HUGE known problem with persons on the spectrum, my daughter only needs to eat 6 things for the rest of her life, and our ABA providers are not allowed to help us with this. –Coast Guard, Hawaii

Since the policy changes my child and many others like him experienced significant gaps in service due to the changes in the authorization process. Thankfully my child has been receiving services long enough that he only experienced regression in some areas. Others are not so lucky. ABA services are just as essential to well being as any other care, so placing additional barriers through "policy improvements" is irresponsible. The frustration regarding the new policies among parents, the children being served and providers is well earned. I foresee many providers choosing to not accept Tricare in the future if something isn't changed soon. Finding providers is difficult as waitlists are 6-18 months long. I'm not sure what data was gathered to justify the policy changes, but I suggest a thorough evaluation of outcomes because from a consumer perspective, the goals of this policy change are NOT genuinely client centered. –Veteran Colorado

The changes not allowing services in school and community have reduced the chances for behavior change generalizing across environments. His last treatment plan was denied because a community location was added. Also, there are differences in the behaviors observed in these environments. Reducing the types of skills that can be treated, reduces the likelihood of skills being developed to help him be more independent. –Air Force, Michigan

Please allow ABA services back in the school environment. It helps my son to be able to get ABA services at school and at home! –Veteran North Carolina

Tricare has been limiting the amount of services my children can receive.Tricare has been making our ABA facility jump through impossible hoops in order to approve services to my children. Therapists are not allowed to work on certain targets because that's "school related" knowing full well the school doesn't do anything to help my children with life skills. ABA should be able to target all the problems that encompass autism but TRICARE does not care about the children!!!! Children who are on Medicaid/medicare recieve better care because they are not tied up by Tricare's stupid policies/demands! Tricare is a joke. These kids deserve better! –Navy, Georgia

The elimination in community outings is severely impacting my son's growth and abilities to live with in his community. I worry daily about the impact this will have on him becoming a productive member of society if we can not go into the community to work on and generalize skills from home to community with support from trained staff to help the transition. I already see the impact and he is only 7. At the play ground we are having more unsafe behaviors to the point where I have stopped going because it doesn't translate from practicing at home and I don't have the support to help me as a parent learn what to do in real life scenarios. –Navy, Florida

There's not enough BCBAs to accommodate the children with ASD needing assistance/ABA at school. These ACD changes have made public school a nightmare. The teachers are not equipped, trained or knowledgeable about Autism. This is including "special education teacher" It's a SHAME for the older kiddos that struggle in our community setting without the appropriate tools to help them LEARN how to perform living skills in the community- grocery shopping, conversations with people in our community, safety challenges, etc. Super selfish. These changes NEED to be reversed as it is failing our children. Our military families puts too much on the line for our freedom. Our children at least deserve all the therapies they can obtain for a better future. I wish you guys apart of the ACD changes could see how it is for our children and how badly they struggle in school settings, social settings, community outings. And the support they need/require. ABA is life changing and crucial for these kids on the spectrum. MEDICALLY NECESSARY. –Army, North Carolina

My entire family suffered beyond measure not only financially due to having to out of pocket support but mentally. Then my sons 3 day a week 4 hour a day therapist just stopped didn't submit complete evaluation because it was too much of a headache. We had no idea. Now we are left after retirement with nothing. 1 in town provider and they want us to start my some ENTIRE autism eligibility over. With 6 month waiting lists. Yep it's great. –Veteran Georgia

DHA says that they want Tricare's ABA to be the best, but the changes made in March 2021 have drastically changed this! The yearly testing requirements have and long wait lists for this have caused delays in receiving ABA. Requiring parents to do the PISA/parent stress index is inappropriate especially some of the personal questions asked!! Tricare doesn't require this for any other therapy! Taking away services in the community where a lot of behaviors occur has caused my child to regress and has greatly impacted his future! Not being able to use ABA for activities of daily living has also greatly impacted and instead of having a better future and living independently, now my child's future will be totally different and uncertain because what is needed for his future has been taken away. Tricare is contributing to the dysfunction of those with ASD and is causing more stress than ever before not less!! The unemployment rate for those with autism is greater than 95% and by limiting what skills can be taught, Tricare is contributing to more ASD kids dependence on others for their entire lives! Delegating parents to teach ABA in the community instead of to the ABA providers is causing regression!! Tricare needs to be changed and make it easier for families and providers! Autism is a lifelong disability and annual testing won't change that! Tricare needs to support families not put up. Roadblocks that make it more difficult! –Veteran Florida

Kids with ADHD will also benefit from ABA therapy so please include and adhd diagnosis. –Veteran Georgia

We pay our child's ABA services out of pocket. The provider we use isn't covered and there are no covered providers in our area that are able to provide the care our child needs. I find Tricare very limiting and not helpful when getting appropriate services for ASD children. We secured ABA through Tricare previously and it was a disaster...but we had to use "approved" providers. Now we take on the financial burden because our child needs the correct help, not the covered help. –Coast Guard, Massachusetts

The stress alone has made a great impact on my life. The stresses that come with being a military spouse were well worth it, if my son was still receiving the ABA therapy he was getting/needed. Taking away 2-key environments have left my family in great shambles. We're talking divorce, retiring earlier, going guard, and finding a civilian job. The stress that has accompanied these changes is MORE than any stress that may come with having a child on the spectrum. Until they have lived a day in my life, they shouldn't be speaking on what therapy is or isn't working for MY child! –Air Force, North Carolina

Significant gap in care experienced as a result of diagnostic testing and DSM checklist requirements. I am unable to locate a provider that can administer these tests without a wait thereby delaying services. –Marines Virginia

ABA therapy is the most important and effective therapy for autistic children. It has helped our child improved their behavior greatly. It's my child's life and future that depends on this Therapy; without it he wouldn't be able to function in society. –Army, North Carolina

Removing toileting from his treatment plan has caused a regression. This is an essential life skill –Air Force, Hawaii

I use Tricare / DHA interchangeably. Lack of community support or focus on activities of daily living is basically sentencing certain children on the autism spectrum to a life sentence inside their homes or a facility. Not having interactions in the community or with peers is detrimental not just to the child but to the family. There can be no quality of life gains if this aspect doesn't change and quickly. My son is terrified of dogs and this is supposed to be fixed inside the walls of my home??? How about his safety in parking lots? How can we address that? Safety around water? Kids have already had tremendous setbacks due to the pandemic. Tricare just adds insult to injury. Our ABA company will also not be taking on new Tricare clients due to the administrative burdens companies deal with due to constant issues with approving treatment plans, lack of payment for additional requirements, and generally that clients and ABA companies are not set up for success. Tricare is pushing ABA companies out because companies would become unsustainable having families with Tricare. Most on the medical and Tricare side have no knowledge of ABA and Tricare's specific requirements for frequent evaluations. Every time we have had to do diagnostic evals, our MTF clinic never process the referrals correctly. At least three different times, we have come within days of losing services due to Tricare. This is with hours spent on the phone and no delays on our part. In one instance, I personally spent 20 hours on the phone trying to figure out what was holding up the process. I was in contact with our PCM team, Tricare, ECHO, patient advocacy and referral management because no one knew what the problem was, only that there was a problem. Which brings us to parent stress. Families know they are stressed, but the parent stress tests cross the line. Anyone who allowed this change to be approved seriously needs to be evaluated for lack of compassion. I think all of these practices show that Tricare discriminates toward children with autism. Autism is a chronic, lifelong medical condition. Tricare doesn't treat someone with diabetes or cancer or any other condition the way it treats autism. Would Tricare ration insulin for a diabetic? Would they question a diabetic if they are making any effort to improve their own health by eating better (which could lead to a cost-saving for DHA)? In fact, this doesn't save anyone money; it means they will be in treatment longer. It means they will graduate school-related services and then passed onto other programming. But these kids are not given the same chance of success as their peers, even their peers who receive ABA but not covered by DHA. We declined a move due to lack of ABA providers and inability to receive services in a timely manner. My husband is command-vectored but we will be retiring after this assignment because we have seen the lack of progress and, in some cases, steps backward that Tricare and the DOD have made towards families that have a child with special needs. This isn't just about my son. This is about my family. This is about my husband honorably serving his entire adult life in the Air Force, but planning to exit as soon as possible because of how the DOD treats its most vulnerable. This is about overreach and ego and money. It's not about the kids. –Air Force, Texas

It's criminal that these benefits are being cut when exceptional children already do not receive support –Army, North Carolina

I feel our ABA therapists do an outstanding job & have made all the difference in the world for me to be able to communicate wants/needs with our nonverbal child. We're finding a rhythm but I know so many tricare parents whose worlds were flipped upside down after these changes because their kids are more medically involved than ours. Until you have a nonverbal child, it's hard to truly understand the struggles. ABA changed our lives. For tricare to consider it place restrictions on what is ok to treat is horrific. Let the medically licensed people that see the children make those calls, not a money minded insurance machine. Veterans/retirees can’t enroll in ECHO so we just eat any extra expenses while bringing in less money than when we were active duty. –Veteran Illinois

Stress and anxiety that our child will lose their ABA arrives because of the constant assessments required to Reestablish autism diagnosis when autism is not curable therefore why would we need to reestablish a diagnosis. We are PCSing and this has added so much stress! –Air Force, Missouri

The biggest issue is Therapists are not allowed to conduct therapy outside of the clinic our home, but some behaviors only occur in external environments. There needs to be some allowance for limited outside of clinic therapies, so the therapist can build a treatment plan after seeing behavior. –Air Force, Illinois

Severely Combat Disabled/Medically Retired could not stay active Duty. The service member's disability and medical retirement is too much money for us to qualify for Medicaid. The Developmental Delay Waiver in our State has over a 7 year wait list. I'm taking care of my husband and my son. Add the CoVid Restrictions, Regression. Our son has already had one inpatient behavioral emergency stay because treatment was delayed. –Army, North Carolina

Extremely disappointed and ashamed of Tricare services –Army, California

ABA is needed. Please don't take it away. It hurts our children. –Army, North Carolina

My stress is related to Tricare's handling of the ABA program. The hoops for ABA are endless. –Air Force, Washington

It's difficult to find ABA providers with each military move. We are lucky that our ABA provider still take TRICARE as there are providers in our area that have stopped taking TRICARE. My husband wanted to continue his military career beyond 21 years, but he turned down a promotion to Col. because we can't risk our son's future. We will receive better health coverage for ABA services if he becomes a government civilian working on post than if we continue in active service. Our family needs help at the grocery store but our BCBA isn't even allowed to go to the grocery store with me so she can teach ME the skills I need to keep my son safe while I shop. We can't have help teaching our son basic life skills like how to brush teeth or put on pants. He's 6 years old and doesn't learn skills like a typical 6 year old. He is so busy flapping his hands or bouncing on his knees that he can't focus long enough to brush his teeth. Before March, our BCBA could help us create strategies to teach our son how to brush his teeth but now we can't have help with that anymore. Before March 2021, our BCBA could teach us and the doctor how to safely examine ****** and avoid meltdowns in the doctors office. We've been without that support for a year and medical appointments are so hard. He's had multiple COVID tests and he's scared. I take him once a month to the doctor's office to get used to the environment and hopefully reduce his anxiety but without the support of a BCBA to help...we aren't making much progress. He will allow the BCBA to listen to his heart in the ABA clinic and even check his blood pressure but this skill isn't translating to the medical clinic with his doctor and we can't have help in the setting that we most need it. We are better off with civilian healthcare coverage than TRICARE. We have sacrificed a lot for our country over the past 20 years but we won't sacrifice our son's medical care. –Air Force, North Carolina

As a 19 year active duty member, I have already decided to retire at 20 years. I chose to do this mainly for my family and specifically because of a lack of faith in DHA and TRICARE due to their implementation of the ACD. My opportunity to progress past my 20 year mark in a specialized career field exists, but I feel like I cannot sacrifice my family's well being. Instead I will retire after command and transition into potentially a government civilian job that offers better healthcare. For an organization that touts people first, this whole situation is incredibly disappointing after an otherwise great active duty career. –Air Force, North Carolina

Bring back ABA in the classroom. My 3 boys are all too "high functioning" to be in an extra help classroom but all do not understand what is going on. I am having to get insurance from the state because tricare has took so much from my children. I have had to choose if my child should get speech- greatly needed, or ABA because they are in school. They also have lost hours from ABA. This is not from the company- the company and RBTs are amazing. This is tricare trying to find how to save money and not have to pay. –Army, North Carolina

The wait times to find an ABA clinic with open slots that take Tricare is a nightmare. We had to wait around 4-5 months to be able to find a new clinic for our son. In the meantime his behavior regressed to patterns not seen since he was 8 (he will wet himself/soil, problems with keeping hygiene, etc; he was 11 at the time, this was about 6 months ago). Finally found a clinic who will work with us and he's back on track but the disruption of services was horrible for our family. –Army, North Carolina

My child went from being able to have a combined 38 hours a week of services between home and school. Because of the change he is only able to get 10 hours a week and no school services. Our hopes this year was with the support of his therapist to help him see if transitioning to more reg Ed classes would be possible as he will go to a new school next year. He has struggled with the change of not having his therapist with him like he had in the past and now this is no longer an option for him. He is in a class with 8 other special needs students and because of shortages there are only two teachers. He has issues attending and getting his work done amongst other things, and we all have seen and felt the affects this has had on us. It has been mentally difficult for myself and my husband as well having to deal with all of this and the way it affects him.

–Army, North Carolina

My son was able to receive in school ABA for two years before the change not allowing RBTs in school. He struggles with social interactions and behaviors. This year we have no ABA in school and he is struggling. He worries about getting in trouble and has developed anxiety about school. ABA helped him work on the correct way to act and behave in a class. He would have benefited from at least one more year of this. Additionally due to this change there are less RBTs working for the e company we were with. I had hoped to continue with some sessions in clinic after school- to work on social interactions that could transfer to the school setting. However the lack of providers meant our sessions repeatedly got canceled. The month of October all our sessions had to be canceled except for three. It was very difficult to work around the cancellations and scheduling issues when both parents are also working. We ended up stopping ABA because of these repeated cancellations. So we have no ABA support. I am not sure what the expanded coverage Tricare spoke of because I do not have any different or new options. I am not sure if that is due to our location (Fort Bragg) or if we have not been made aware. It is unfortunate that the one option we had that was making a difference and encouraging my son to socialize with his peers has now been taken away. The new program has not improved the care of my child it has only created more stress and anxiety for him. –Army, North Carolina