Defense officials need to review their special needs health care coverage to make sure it meets the needs of military families, according to a new report from government auditors.
The Government Accountability Office looked at the Tricare Extended Care Health Option, known as ECHO, and its ECHO home health care benefit, known as EHHC. Military families may face challenges getting access to these services, which help individuals keep, learn or improve skills and functioning for daily living; provide durable medical equipment and incontinence supplies; and offer caregiver support, such as respite care.
Families with special needs may have difficulty getting access to the services they need, especially because of frequent military moves.
The coverage may be outdated, with the amounts at the same level since 2009, auditors noted in a GAO report published Monday.
Because of rising health care costs, the Defense Health Agency “lacks reasonable assurance that ECHO benefits, including EHHC services, are fully meeting the program’s purpose of mitigating the disabling effects of a qualifying condition,” auditors stated.
The coverage limit for the ECHO program has remained at $36,000 per enrollee per calendar year since 2009, when lawmakers last authorized an increase.
Auditors said that with inflation, that equates to about $24,000 in 2025 dollars.
About 27,000 eligible dependents were enrolled in ECHO in 2024, according to DoD. Most of these are children with intellectual, developmental or physical disabilities or other significant health needs.
Eligibility and other requirements and coverage vary between the service branches. Of the total ECHO population, about 1,000 were homebound with complex medically complex conditions and qualified for the ECHO home health care benefit.
But out of those 27,000 enrolled, only about 4,235, or 16%, used the ECHO services, auditors stated.
In their response to a draft report, DoD disagreed with the GAO recommendation to assess whether the coverage limit of $36,000 is enough.
They stated that in 2024, the 4,235 enrollees had an average total government expenditure of $6,600. That $36,000 coverage limit is set by law; those who require the ECHO home health care services aren’t subject to the cap. Auditors noted that a review could provide information for any potential congressional action.
Lawmakers required GAO to conduct this review of the coverage for nursing care, habilitative programs and respite care through Tricare ECHO and other federal programs.
ECHO respite care services must be provided by a Tricare-authorized home health agency, to provide a short-term break for the usual caregiver. The ECHO program allows up to 16 hours per month.
The auditors also reviewed state Medicaid home- and community-based services, such as skilled nursing care and respite care, in seven states with high military populations.
Military families may be eligible for this care, which in some cases may offer more benefits than ECHO, but access can be limited. Auditors cited a study that found in 2025, it took about 32 months to move from a waiting list to enroll in one of these state programs. Families have said that by the time they can receive the services in a state, it’s time for them to move.
DoD is in the process of standardizing its eligibility requirements, and the number of respite care hours offered across all the military service branches through the Exceptional Family Member Program. DoD officials told GAO auditors that they expect to fully implement standardization of the respite care services by October 2027, and those with profound need would be eligible for up to 32 hours of respite care per month.
Of all the services GAO auditors reviewed, respite care was the most frequently requested from 2022 through 2024, according to data from one of the Tricare managed care contractors.
But about 68% of the authorizations for services weren’t used by the families. Defense Health Agency officials told auditors shortages of respite care providers may contribute to unused services. The shortage can also delay or limit access to nursing care services for military families.
Low respite care hours and low reimbursement offered by ECHO may also contribute to challenges in getting providers, according to the GAO report.
Two ECHO case managers told auditors that even if the respite hours increased to 32 hours per month, it would still be hard to find providers, since respite care providers want more hours than that.
Karen has covered military families, quality of life and consumer issues for Military Times for more than 30 years, and is co-author of a chapter on media coverage of military families in the book “A Battle Plan for Supporting Military Families.” She previously worked for newspapers in Guam, Norfolk, Jacksonville, Fla., and Athens, Ga.
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