Tricare Limits ABA Therapy Coverage

Tricare Limits ABA Therapy Coverage

According to officials with Autism Speaks, a group that advocates for and researches autism, the new requirements in Tricare will limit access to ABA therapy for children.

In May, Tricare added limitations and restrictions to Applied Behavior Analysis (ABA) therapy, particularly in schools and community settings.

Katrina Powers, a parent whose daughter has participated in ABA therapy, expressed concerns over the changes that would affect her daughter's education. The support Powers got from the school made a big difference in her daughter's schooling and her grades improved, she said.

On top of it being really hard on her mentally and emotionally, we also are not receiving therapy because Teagyn's day is so long. If we go from school, we rush home, take a little break, rush back to therapy, it's just not feasible," Powers said.

It is worth noting that individuals covered by Tricare can still receive ABA therapy, but in a more limited capacity and not throughout the school day. According to families, the monthly cost of hiring an aide would exceed $6,000 without insurance.

Amy Sparks, the principal of School of Hope in Fayetteville, Ark., said the changes are a disgrace to the nation's military families.

A spokesperson for Tricare said in May that the changes were made after the company spent three years working with industry stakeholders and learning from their mistakes.

While this is a new requirement that came into effect on May 1, 2021, it has never been intended to reimburse for non-clinical or educational services. There is a possibility that the Tricare Comprehensive Autism Care Demonstration may compensate ABA programs that are active in delivery.

According to Greg Steele, U.S. Representative Richard Hudson's spokesperson, a study would look at the program's impact and include direct feedback from parents and stakeholders.

While parents like Powers wait for their children not to suffer, they are still hoping for the best.