Military families may get better access to mental health care

Military families may get easier access to mental health outpatient care and counseling under two new provisions in the recently signed defense policy law.

The fiscal year 2024 National Defense Authorization Act allows Defense Department health officials to waive out-of-pocket costs for the first three outpatient mental health visits each year for active duty families using Tricare. It also expands non-medical counseling services for military families through the Military and Family Life Counseling Program.

But the Defense Department hasn’t yet decided whether to make the cost cuts a reality for the more than 1.5 million active duty family members who could benefit from the new law. The Defense Health Agency is reviewing the provision and “has not made any decisions regarding its implementation,” said spokesman Peter Graves.

The provision says the defense secretary “may” waive the costs of certain mental health services for military families, but doesn’t require the Defense Department to do so.

If the Pentagon carries out the law as written, it would expand the military’s access to mental health care amid a nationwide shortage of providers and appointments.

The provision that allows DOD to waive out-of-pocket costs for three mental health visits applies to active duty families using Tricare Select, which currently requires a co-pay of $31 or $38 for mental health outpatient care per in-network visit.

The $38 in-network co-pay in Tricare Select applies to family members classified in “Group A” — those whose sponsor entered the military before Jan. 1, 2018. Beneficiaries in “Group B,” whose sponsor entered on or after Jan. 1, 2018, have a $31 co-pay for mental health outpatient visits under Tricare Select.

The provision also applies to active duty families in Tricare Prime, who aren’t subject to a co-pay unless they seek non-emergency care without a referral — known as the “point-of-service” option. Whether the cost waiver would apply to point-of-service options depends on how defense officials implement the law.

Active duty members, who must enroll in Tricare Prime, pay nothing out of pocket for their health care.

Eileen Huck, senior deputy director of government relations for the National Military Family Association, said the organization supports the provision but wishes the law did more to reduce the cost of accessing mental health care.

”Three visits might be enough for some patients sometimes, but the majority of time people are going to need more than three mental health visits,” Huck said. “We’re concerned that costs will continue to be a barrier to accessing care.”

In addition to active duty families, the new law also offers the waivers for those in a Tricare Young Adult health plan. Those family members are unmarried, adult children of an eligible sponsor, who are at least 21 years old but not yet 26, can’t enroll in an employer-sponsored health plan through their own job, and aren’t otherwise eligible for Tricare coverage.

The wording of the law creates an odd twist for this new benefit, Huck said.

“Most Tricare Young Adult beneficiaries are retirees’ kids, so they will be eligible for the three mental health visits with no co-pay,” she said. But other members of the same retiree’s family, including parents and younger siblings, wouldn’t be eligible.

“However, we appreciate that Congress has recognized the cost burden of Tricare Young Adult as well as the mental health challenges faced by so many young people, and has acted to make mental health care more affordable for them,” Huck said.

The law empowers military families to receive the treatment they need, said Sen. Jon Ossoff, D-Ga., in a press release about the bipartisan provision.

It “will expand free access to counseling and mental health services for military families, who make great sacrifices for our nation, endure great stress in so doing, and deserve nothing less than the care they need when they need it,” said Ossoff, who introduced the language with Sen. Kevin Cramer, R-N.D.

More non-medical counseling

The law also expands non-medical counseling available through the Military Family Life Counseling Program, run through the DOD family policy office, separate from the defense health program. The law allows these licensed mental health care professionals, including DOD civilian employees and contractors, to provide non-medical counseling in person or online, regardless of where they are located.

These professionals offer free short-term, confidential counseling on issues like deployment adjustments, stress management, moving preparations and getting settled afterwards, improving relationships, work problems and grief.

The new law allows counselors to work with families in any state, not only in those where they are professionally licensed. Those licensing restrictions made it more difficult to fill counselor positions in certain locations, prompting military family advocates to push for change.

“There’s a recognition that non-medical counseling has to be a big part of the mental health equation, that there just aren’t enough health care providers, and that [Military Family Life counselors] provide really valuable services,” Huck said. “I think DOD and the services are really pleased with the MFLC program, and by expanding the locations where they’re able to practice, it’s going to make a big difference in making the program more available to more families.”

The counselors serve active duty, National Guard and Reserve troops, as well as their immediate family members or their survivors. They work in military communities at local units, family centers and in other locations, such as some military-run schools and some civilian schools in military communities. They provide counseling for individuals, couples and groups.

Nearly half of the military spouses who participated in DOD’s 2021 survey of active duty spouses reported using counseling during their spouse’s career. About 1 in 5 spouses reported using counseling services within the previous six months.

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