Citing upcoming changes in the military health care system, a high-level Defense Department advisory council will be focusing on how those changes affect military families.
The DoD Military Family Advisory Council voted to make that a primary area of focus in 2020.
“This is an area where there’s going to be a great amount of turbulence associated with the redoing of our health care system, so ultimately it’s really important that we understand how it’s impacting our families as we make these changes,” said James Stewart, acting under secretary of defense for personnel and readiness and chairman of the council. “These are wholesale, large changes to the way we provide care to our beneficiaries, not necessarily to the members, but certainly to our members’ families.
“That will have a huge impact. I’d be very intrigued to see and monitor how it affects the families.”
The military health care system has been undergoing reforms, which began implementation in 2018, including fewer Tricare regions, with new contracts that took effect in 2018. Families in many areas have had trouble finding health care providers who accept Tricare, and many complained about their increased costs.
But DoD is also in the process of changing the entire structure of the system, moving the management and administration of hospitals and clinics away from the Army, Navy and Air Force, to the umbrella of the Defense Health Agency. DoD has also been looking at “rightsizing” the system, with an 18 percent cut in medical billets.
This summer, DoD is expected to issue a report with details on which military medical facilities will be closed, which will be downsized, and which ones will be ramped up.
And DoD is reportedly rethinking the entire structure of its contracts for health care in the civilian community, which could include smaller Tricare regions and possibly agreements with some high-performing civilian health care systems. Across the board, these changes are being referred to as Military Health System reform.
“It’s important for our feedback as representatives of military families to be considered as the process unfolds and decisions are being made, versus after it’s already implemented and becomes much more difficult to change course,” said council member Karen Ruedisueli and government relations deputy director for the National Military Family Association.
Based on their work in the previous year, the council also voted on recommendations they will provide to acting Secretary of Defense Patrick Shanahan — with the first priority being improving service members’ access to military child care. They will also forward recommendations related to spouse licensure portability, military housing problems, and policies related to gaining access to dependents’ medical records when a former dependent enters the military.
Sergeant Major of the Army Dan Dailey, a member of the council, said that child care is the No. 1 issue he hears about as he travels around to meet with soldiers and families. “We provide, I believe, world class child care, but we still need more,” he said.
Army Lt. Gen. Gwen Bingham, assistant chief of staff for installation management, said she briefs senior leadership monthly on the issue of child care accessibility. The issue “transcends more than just the Army,” she said, adding that DoD and the services can continue working to find solutions to the growing need. The recommendation, brought forth by Bingham and Dailey, calls for adequate funding to meet the demand for child care, hiring child development center staff in a timely manner with background checks completed, and finding ways to expand the family child care programs in approved, licensed homes on installations.
For decades, service members and spouses have been frustrated by the shortage of child care spaces on many installations. Service leaders and members of Congress have acknowledged the problem, and taken various steps, but it remains a top issue in many military communities.
Recommendations related to military spouse professional licensure portability and military housing were tied for the second priority in the council’s voting.
The council approved a recommendation to support the DoD’s state liaison office’s work with states to:
- improve licensure portability
- expand tuition assistance to be used by both service members and their spouses who want to pursue professional licensing and technical certification
- continue to address mobility and portability areas of concern for service members and their spouses
In the wake of the current issues with mold, lead-based paint, vermin infestations and other problems with some military housing, and families’ frustration in getting their health and safety issues addressed, the council recommends that DoD determine the current public health concerns about military housing, and the remediation efforts under way. They recommend establishing a DoD working group — to include nonprofit and public health professionals to review and make recommendations about the accountability systems — with access to resident satisfaction surveys. DoD would review corrective actions, including recourse for families.
The fourth priority is delving into the impact of the services’ policies related to their access and evaluation of medical records of minor military dependents when they enter the military.
A number of military families have raised concerns about notations in children’s medical records that have surfaced after the son or daughter joined the military, and they were forced out — even if the medical issues noted were long ago resolved or there were mistaken notations. Military officials are merging the minor dependent medical records with their new military medical record when they join the military. This is not the case with recruits from civilian families, because the military doesn’t have access to those records due to privacy laws. Concerns have been raised by many that this could discourage parents from seeking behavioral health care for their children, for fears it could ruin their chances for a military career.
“It’s affecting a lot of military families. When medical records are accessed directly for active duty dependents or retiree dependents, they are being asked to do a lot [to address] past history. It’s not just mental health, it’s other things that affected the dependent when they were younger,” said Navy wife Evelyn Honea, also a council member.
“For example, friends of mine had to spend a lot of money on tests now that they’re retired to prove that the child was not affected by this any longer. They just gave up because the tests were very expensive. So the child didn’t get accepted into the Navy, but is qualified to get accepted into the Army officer program."
Bingham said the issue is “also tied to recruiting in a big way.”
Among the recommendations were to form a DoD team to conduct further research and analysis on the effects of the policies regarding access to dependents’ medical records; the guidelines the services are using when evaluating information in a dependent’s medical record, and how it’s used in determining whether the dependent is “fit for duty.”