Military Families vs. United States of America, U.S. Department of Defense, TRICARE Management Activity, and Secretary of Defense Robert M. Gates

It does not feel good to bring a lawsuit against the very country and government that you took an oath to serve and protect, and knowing that to uphold that oath might possibly come at the expense of your own life. On the flip side, our families who take the oath to serve and protect this great country expect our government, to provide the medical care and family supports that our families require to, uphold our oath to serve and protect our great nation.

In spite of the lack of medical care and family supports, our men and women in uniform have upheld their oath. In spite of the lack of medical care and family supports, our spouses have held down the home fronts’ . We have upheld our end of the oath and in doing so we all have paid a heavy price, but none heavier than the price our children have paid. Over the years I have spoken with many service members who have been wounded in action; “wounded warriors’. Every single one of them has told me that what they have endured pales in comparison to what our children with autism endure. Our government has failed to provide medical care, and our military dependent children with autism have been the ones left laying wounded on the battlefield. The very government we swore to protect could care less, and we have simply had enough.

In the summer of 2005 TRICARE implemented the Extended Care Health Option (ECHO) Program, and acceptance into this program is the only way a military dependent child with autism can receive medically necessary Applied Behavior Analysis (ABA). Keep in mind the child must be accepted into this program and that determination is made by someone sitting behind a desk that has never met, let alone examined, your child. If your child is accepted into ECHO, there is no guarantee that they will receive ABA as the child’s program must be run and/or overseen by a BCBA or a BCABA who is a TRICARE provider. We all know BCBA’s and BCABA’s and are in high demand and short supply. To top all this off, TRICARE capped the annual benefit for ABA at $36,000. Retiree’s dependents are not eligible for ECHO, nor are those not on active duty, in the Guard and Reserve even though they are in most cases eligible to receive basic TRICARE benefits or have the option to purchase them as one would regular health insurance.

On June 24, 2010 I received a letter (see attachment below Military Families Letter) put forth by Mantese, Honigman, Rossman & Williamson, P.C. I’ve been waiting a very long time to see this come about for our military dependent children with autism. What far too many don’t understand is that yes, on paper, our kids have the ABA benefit, but what most don’t realize is that consistently over the past five years, less than 10% of dependents with autism are enrolled in ECHO because of a laborious enrollment process, and confused people charged with not only getting the information out, but the enrollment process as well.

My feeling, simply speaking as a parent, is that TRICARE is just fine with that. It lowers their expenses by decreasing paid claims, and increases their bottom line. That makes the Department of Defense happy because we all know that no one wants to pay for medically necessary care related to autism. If you read the letter sent to military families from the Attorney’s (see attachment below Military Families Letter) you will see that the DoD claims that TRICARE Management Activity (TMA) “has not made a formal policy determination as to whether ABA services might be covered as a Basic [Tricare] Program medical benefit”.

Like I said, I’m just speaking as a parent, and one who has had a few conversations of her own with the General quoted in the letter from the Attorney’s, but I can not think of any way to make a more formal statement than DoD and TMA already have. TMA has clearly stated in their Policy Manual for YEARS that ABA is only available as a “special education benefit” through acceptance into the ECHO Program, which is completely separate from the basic TRICARE benefits. Any change to the TMA Policy Manual must be done through the National Defense Authorization Act (NDAA), and that requires legislation being passed typically in both the House and Senate and then the House and Senate versions are essentially meshed to provide something everyone is happy with that the President then signs into law. This happens every year; it is how we got an increase of $2,500 a month to $36,000 a year for ABA, and exactly why we have continually asked Congressional leaders to introduce and get passed, language that would move the ABA treatment under the basic TRICARE program, and do away with the annual cap. Forgive my sarcastic and somewhat jaded tone, but phaleeeze… The DoD just wants the Berge case dismissed because if it is, then the DoD won’t face the risk of having to compensate military families for what they should have been providing all along, which is access to medically necessary treatment for autism without the discrimination of the ECHO Program, equal access for Retiree’s dependents, and the option for Guard and Reserve to access these benefits as well.

There are four affidavits available for you to review; one for spouse’s of active duty members, one for spouse’s of retiree’s, one for active duty members, and one for retired members. If you can truthfully attest to and sign one of these affidavits, please do so and return it by July 5, 2010, to:

Brendan Frye, Esq.
Mantese, Honigman, Rossman, and Williamson, P.C.
1361 E. Big Beaver
Troy, MI 48083

Or email it to:

The Department of Defense has already had an opportunity to correct this situation, multiple opportunities in fact, and the same is true for Tricare Management Activity. This is an opportunity for all military families who have dependents with autism to have their voices heard on behalf of all our children. As a parent who has lived this nightmare and been contacted by so many who have lived the same, at this point, I would trust a judge before I would trust the DoD and TMA. DoD and TMA left my boys on the battlefield. I had to go retrieve them on my own.

Disclosure: I have no idea if our family will be included in the class action, but yes I am signing the active duty spouse affidavit. I was made aware of this situation because I have been involved in the legislation pertaining to the issues for almost 3 years, and my son went without medical care in the form of ABA for 3 years due to TMA and DoD policies.

Bio: Angela Warner is an Air Force spouse and mom to four children under the age of 11. Her older two children are recovering from autism. Angela is the Military Contributing Editor for Age of Autism, the DoD Liaison for SafeMinds, and one of Autism One’s Liaison’s for Military Families.

General_Affidavit.pdf65.44 KB
Autism_Complaint.pdf339.46 KB
Motion_for_Summary_Judgment.pdf4.91 MB
Spouse_Affidavit Active_Duty1.pdf3.63 KB
Active_Duty_Affidavit21.pdf3.64 KB
Military_Families_Letter_6.24.10[2].pdf213.33 KB
Retiree_Affidavit.pdf47.66 KB
Spouse_Affidavit.retiree.pdf47.74 KB
Reserve National_Guard_Affidavit.pdf47.93 KB
6-30_Letter_from_TMA_to_Humana.pdf53.39 KB

just for sharing

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I think these people who represent the State are not able to respect those who have brought glory to the country. Their families must be honest as it should because it represents America and the American dream. Where would we be without them now.
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added lawsuit

attached now is also the full lawsuit

reserve and national guard affidavits

I've uploaded a new document for reserve and national guard affidavits. There is no difference in spouse or military memeber for that one.

deadline extended to Jul 15

please send in your affidavit or your story. If you missed Angela Warner on Linderman Live today, look for the archive copy on AutismOne Radio