An estimated 137,000 civilians may soon receive bills for medical care they received at military treatment facilities over the last three years, according to Defense Health Agency officials.
Those civilians, who aren’t eligible beneficiaries of military medical care, include a variety of people, from Department of Defense civilian employees to other civilians who received emergency and trauma treatment at any military treatment or clinic, both overseas and stateside, since June 21, 2023.
Military medical facilities can provide care to individuals who aren’t eligible beneficiaries in certain circumstances, by law, usually on a reimbursable basis. But the high cost of medical care was putting some of these civilians in financial distress. So Congress passed a provision in the 2023 National Defense Authorization Act that gave DOD the authority to protect patients from financial harm, to apply a sliding fee scale and catastrophic fee waiver.
The billing was paused in June 2023 in order for DOD to develop the new Military Health System Modified Payment and Waiver Program, to help these civilians who face financial difficulty.
Once the patient receives a medical bill, if they face financial harm, they are encouraged to apply for the program, officials stated in an email response to questions.
“We encourage all non-beneficiary civilians who received treatment in an MTF or clinic after June 21, 2023 to take full advantage of this program to see how much financial relief they may qualify for when they receive their bill,” officials stated.
While officials did not provide a timeline for the bills, a Feb. 6 Federal Register final rule implementing the program stated it became effective March 9. Information was not available about the estimated total amount of the billing. Each individual bill will vary and is determined by the length and type of treatment.
According to the Military Health System, if patients have other health insurance, the military hospital or clinic where they received care will file medical claims on their behalf. The patient will be responsible for copays, coinsurance, deductibles, nominal fees and non-covered services.
Those without health insurance will get a bill from the military hospital or clinic where they received care.
Each bill will include instructions on how to apply for financial relief through the program.
All complete applications will be evaluated based on the standards outlined in the final rule, applying a sliding fee scale and catastrophic waiver benefits, officials said. The final rule also guarantees flexible installment plans to allow patients to spread out their payments over up to 72 months.
The Federal Register rule outlines an initial process for determining the sliding fee discount and catastrophic fee waiver, using the Federal Poverty Guidelines. Those whose annual household income is at or below 100% of that year’s Federal Poverty Guidelines may receive a full discount on their bill; others receive discounts based on the sliding scale. Those federal guidelines are based on annual household income and family size.
For example, for those in the U.S., except for Alaska and Hawaii, a household of four people with an annual income of $32,150 would be at 100% of the federal poverty level in 2026.
Instructions for applying for financial relief are also available at the MPWP web page. Patients can also contact the Defense Health Agency’s Debt Adjudication office for assistance, Monday through Friday, 8 a.m. to 5 p.m. Central Standard Time at 210-295-3344, or by email at [email protected].
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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