Military families do not need another forum that acknowledges their struggles without confronting the policies responsible for them.
Watching the Military Spouse Commission’s inaugural meeting on Monday, I wanted to see meaningful accountability. As a military spouse, mother of an autistic child and founder of the Military Family Advocacy Group, I have every reason to want this commission to succeed.
But I came away disappointed.
The meeting raised legitimate concerns about housing, spouse employment and income, childcare, continuity of medical and mental healthcare and veteran healthcare. Each deserves attention. However, what I did not hear was substantive discussion of the specific TRICARE barriers that leave vulnerable families with coverage on paper but inadequate access to treatment.
The barriers also include denials of services that treating clinicians consider medically necessary; explanations that rely on internal manual provisions without meaningfully addressing clinical evidence; concerns about the independence of appeals; burdensome provider certification requirements; and issues within the Autism Care Demonstration.
After 12 years under the Autism Care Demonstration, will applied behavior analysis finally become a permanent TRICARE medical benefit? Will military families receive the same enforceable mental health parity protections afforded to Americans in civilian health plans subject to federal parity law?
For children with substantial support needs, these are consequential questions. Their development does not pause while adults debate administrative responsibility.
Another barrier comes in the form of inaccurate provider directories that can conceal care deserts behind the appearance of adequate networks.
MFAG’s ABA provider directory audit summary documented at least one issue in 171 of 195 listings across six South Carolina audits — 87.7%. The most common issue involved providers recorded as no longer employed at, or not providing services at, the listed location.
These findings describe the audited listings, not a nationally representative sample. They do not establish that every flagged provider was unavailable everywhere. They raise a practical question: How can families find care when the information directing them to it is unreliable?
Our findings sit alongside longstanding federal concerns. In 2024, the Government Accountability Office estimated that most behavioral health provider listings in the TRICARE network directories it examined contained inaccuracies, including incorrect locations and telephone numbers.
The Military Family Advocacy Group’s preliminary summer field intake adds a human dimension. Participating families reported missed duty hours, difficulty concentrating and consideration of early military separation linked to autism care denials.
Providers described uncompensated administrative work and disruptions to treatment. These self-reported experiences do not establish military-wide prevalence or prove causation. They identify concerns the commission should investigate: healthcare barriers can consume spouses’ working hours and undermine service members’ ability to focus on their duties.
Denials deserve equally serious scrutiny. A clinician’s recommendation does not automatically establish coverage under every applicable benefit rule. But families deserve explanations that address the evidence, distinguish medical necessity from coverage exclusions and identify the authority behind the decision.
A manual citation identifies a rule. It does not establish that the rule is clinically justified or beyond reform.
TRICARE provides multiple appeal levels, including reconsideration and, in qualifying cases, an independent hearing. However, its published process places final decision-making authority with DHA leadership or the assistant secretary of defense for health affairs. That structure warrants examination of whether review is sufficiently independent, clinically informed and timely.
MFAG brought these concerns to the new Military Spouse Commission.
As of this writing, we have received no response. An inaugural meeting cannot address every submission, but meaningful engagement requires a transparent process for evaluating concerns and reporting what happens next.
The meeting’s emphasis on legislative solutions also left a critical question unanswered: Which problems require Congress, and which can departmental leadership address now?
Congressional offices have repeatedly directed MFAG back toward DHA and its departmental leadership. Families should not have to shuttle between institutions while responsibility remains unresolved.
Some reforms require legislation or appropriations. DHA’s position within the department does not erase statutory limits. But those limits should be identified specifically. The commission should ask which barriers arise from statute, regulation, agency policy, contract administration or failures to enforce existing requirements.
Then it should recommend action at the appropriate level.
A credible next step would be a dedicated TRICARE review involving affected families, treating clinicians, disability advocates and providers. Its priorities should include denial explanations, appeal independence, certification burdens, Autism Care Demonstration restrictions and verified appointment availability.
Recommendations should identify responsible offices, deadlines and measurable outcomes. Success should mean families obtaining appropriate care sooner, with fewer preventable interruptions and administrative obstacles.
Autistic children, people with disabilities and beneficiaries with intensive medical and mental health needs must be explicit priorities. Their needs cannot disappear beneath broad promises to improve access.
One meeting does not determine whether this commission will succeed. But the opening discussion fell short of confronting the barriers that matter most to many families already struggling.
We want the commission to prove our skepticism wrong. Its access to national leadership creates an opportunity to demand answers and advance meaningful reform.
Whether it becomes a viable solution or another bureaucratic dog-and-pony show will depend on what changes after the livestream ends.
Mariah Wilkins is the executive director and principal policy advisor of the Military Family Advocacy Group.
