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Military Personnel: Opportunities Exist to Improve Access to Services Supporting Caregivers of Dependents with Special Needs

GAO-22-105204 Published: Jun 29, 2022. Publicly Released: Jun 29, 2022.
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Fast Facts

Military families move frequently—which can be particularly hard for families who have dependents with special needs. To help, DOD offers a "respite care" benefit, which provides a temporary caregiver to give the family's primary caregiver a break.

DOD is working on improving access to respite care, with a goal of doubling the benefit's hours to 32 per month by 2025.

In 2022, DOD eliminated a requirement that had prevented families from using the benefit. But we found that another benefit requirement could be preventing access because of DOD's miscommunication about it. We recommended clarifying the requirement, and more.

Military family

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What GAO Found

The Department of Defense (DOD) offers eligible military families several services to support caregivers of special needs dependents. Stakeholder organizations GAO interviewed identified these services as key to supporting caregivers, particularly respite care—in which a provider temporarily cares for the special needs individual. Through the TRICARE Extended Care Health Option (ECHO) program, active duty military families with special needs dependents may obtain respite care, care coordination, training, and some supplemental services. Military families may obtain additional support services through their military branch's Exceptional Family Member Program (EFMP) or state Medicaid programs. However, services available vary by military branch and by state.

Department of Defense (DOD) Programs Supporting Military Members' Dependents with Special Needs and Their Caregivers, 2021

Department of Defense (DOD) Programs Supporting Military Members' Dependents with Special Needs and Their Caregivers, 2021

Note: Numbers are rounded to the nearest thousand. For more details, see fig. 1 in GAO-22-105204.

DOD has recently taken steps to address two policy barriers to accessing respite care. In 2021, DOD issued a rule eliminating the requirement for ECHO enrollees to receive a concurrent benefit (e.g., incontinence supplies) to qualify for respite care. DOD is also taking steps to increase the number of respite care hours from 16 to 32 hours per month. DOD officials expect to implement this by 2025.

However, GAO found that Defense Health Agency (DHA) officials miscommunicated requirements for accessing ECHO respite care to EFMP officials, who help refer families to resources like ECHO. Specifically, DHA officials informed EFMP officials of a requirement that another adult remain present during the provision of ECHO respite care. DHA officials told GAO that this is not a TRICARE policy, rather that some home health agencies require this out of concern for the dependent's safety. EFMP officials from one military branch stated that this requirement effectively renders the respite care benefit unusable for eligible families. In addition, GAO found that DOD does not have data on the extent of unmet need for ECHO respite care. TRICARE's two managed care support contractors—the entities responsible for coordinating respite care—collect some data on unmet need for ECHO respite care. However, these data are limited and the contractors are not required to report it to DHA. As such, DHA cannot assess why, in 2021, only about half of ECHO enrollees authorized to receive respite care (175 out of 341) ultimately utilized this benefit and cannot identify strategies for increasing access to this benefit.

Why GAO Did This Study

Caregivers of dependents with special needs can experience negative consequences from their caregiving roles, such as stress and lost wages. Military families with special needs dependents face additional caregiving challenges due to frequent moves to new duty stations. To address the needs of these military families, DOD provides caregiver support services, such as respite care, through its military branches and the TRICARE health care program. Congress included a provision in statute for GAO to review certain caregiving services available to military families. This report (1) describes respite care and other key services for supporting caregivers available to active duty military families through ECHO and other programs, and (2) examines barriers military families may face when seeking to access respite care and actions DOD has taken to address those barriers.

To perform this work, GAO reviewed DOD program policies regarding caregiver benefits. GAO also interviewed DOD officials, TRICARE representatives, state Medicaid officials, and stakeholder organizations representing military families and the special needs community.


GAO is making two recommendations to DOD, including 1) to communicate in writing that there is no TRICARE requirement for another adult to remain in the home during the provision of ECHO respite care, and 2) to collect and analyze data regarding the utilization of ECHO respite care. DOD concurred with both recommendations.

Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Defense The Director of the Defense Health Agency should communicate in writing to each military branch's EFMP that there is no TRICARE requirement that another adult remain in the home in order to access ECHO respite care and determine if additional training is needed to inform EFMP staff on ECHO program requirements. (Recommendation 1)
In February 2023, Defense Health Agency (DHA) officials stated that DHA will complete a manual change request that adds a paragraph to the ECHO respite care manual clarifying ECHO respite care requirements. This clarification will provide written instruction to the TRICARE contractors that ECHO respite care does not require the presence of an adult (other than the clinician providing services) to remain in the home in order for such care to be covered under the ECHO benefit. DHA expects to make this change by April 2024.
Department of Defense The Director of the Defense Health Agency should collect and analyze data on the utilization of respite care among ECHO enrollees to include reasons why caregivers do not utilize this benefit, and use these data to help ensure it is providing needed respite care by, for example, helping DHA assess the extent of unmet need and identifying strategies for overcoming barriers to access to respite care. (Recommendation 2)
In February 2023, DHA officials stated that DHA will evaluate the feasibility of various options for data collection (such as surveys, claims analyses, and creating requirements for the TRICARE managed care support contractors to collect specific data and provide detailed reports). DHA will then analyze the collected data, assess gaps in access to high-quality respite care to the extent feasible, and formulate strategies with the purpose of improving access to ECHO respite care for eligible beneficiaries within the parameters of the TRICARE statute. Further, DHA will continue to work with the military services to coordinate EFMP programs with the ECHO program. DHA expects to complete these steps by May 2024.

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