Senators press Pentagon to cover autism therapy under TRICARE
Sens. Kirsten Gillibrand and Eric Schmitt asked the Defense Department to make ABA therapy a basic benefit for military families.
By Tom Brennan · Health & Medicine Correspondent
3 min read
Two senators are urging the Pentagon to change TRICARE rules so military families can receive broader coverage for autism therapy. The request puts new pressure on the Defense Department after families said the military health plan has blocked or limited care that many insurers cover.
Sens. Kirsten Gillibrand, D-N.Y., and Eric Schmitt, R-Mo., sent a letter Friday to Defense Secretary Pete Hegseth asking the department to remove TRICARE requirements that have led to denials for some applied behavior analysis services, NBC News reported. Gillibrand and Schmitt sit on the Senate Armed Services Committee, which oversees the Defense Health Agency and TRICARE.
ABA therapy is used to help children with autism build communication and daily living skills, according to NBC News. The senators’ letter asks the Defense Department to classify ABA therapy as a basic TRICARE benefit, a change advocates say would reduce barriers for military families seeking care.
The letter followed an NBC News report about military families and retirees who said they have faced obstacles getting TRICARE coverage for therapies for children with autism. One family in the report was the Cabiao family, whose 10-year-old son, Logan, has a severe form of autism, is nonverbal and needs constant supervision and care.
Logan receives TRICARE through his father, Mario Cabiao, a retired Air Force pilot, NBC News reported. His mother, Kristi Cabiao, told NBC News that Logan had received ABA therapy for years and that the treatment had changed the family’s life.
According to NBC News, TRICARE added new ABA coverage requirements in 2021, reducing the range of covered services and creating additional access hurdles. The military program later restricted behavioral therapy coverage for Logan, NBC News reported.
Gillibrand said in a Friday news release that military families should not be denied essential care for children with autism. She said TRICARE’s refusal to make ABA therapy a basic medical benefit has left service members trying to secure limited care through a difficult bureaucracy.
Kristi Cabiao, who founded a nonprofit to lobby lawmakers for changes to TRICARE autism coverage, told NBC News she was encouraged by the senators’ public push. She said she frequently meets with lawmakers on Capitol Hill and last visited in March.
Cabiao told NBC News that some lawmakers had warned her this year that budget constraints and Defense Health Agency funding limits would make changes unlikely. She said Gillibrand and Schmitt have remained consistent supporters of ABA benefits for TRICARE beneficiaries.
Both senators were involved in seeking an independent review by the National Academies of Sciences, Engineering and Medicine, NBC News reported. That review recommended that TRICARE update its coverage policies to include ABA therapy as a basic benefit.
The Defense Health Agency, which runs TRICARE and is part of the Defense Department, declined to comment for NBC News’ earlier report and did not immediately respond to questions about the senators’ letter, according to NBC News.
NBC News has also reported broader problems for TRICARE beneficiaries after the Defense Health Agency changed the contractor administering benefits in the Western region. Families reported billing mistakes, delayed reimbursements and denied claims, and TriWest Healthcare Alliance later issued a public apology for coverage problems, according to NBC News.
This story draws on original reporting from NBC News.