Resource Spotlight: How Can TRICARE Help Military Families Affected by Autism?

Resource Spotlight: How Can TRICARE Help Military Families Affected by Autism?

TRICARE is the health care program for military service members, retirees, and their families. It helps cover health plans, special programs, prescriptions, and dental care.

TRICARE and Autism

TRICARE covers many services for people with autism.  Depending on your TRICARE plan and the services that you need, you may need a referral, prescription, or preauthorization.  Applied behavior analysis (ABA) services require a referral and a preauthorization through the Autism Care Demonstration.

Services include:

• Occupational therapy (Note: does not cover job training or vocational assessments)
• Physical therapy
• Physician services
• Psychological services
• Psychological testing (Note: does not cover testing used only for school placement)
• Prescription drugs
• Speech therapy (Note: does not cover special education services provided by schools for kids ages 3–21)

How to Get an Autism Diagnosis Through TRICARE

Step 1: Start with your child’s primary doctor. If you have concerns about your child, make an appointment with your child’s primary healthcare provider.  Talk about your concerns and request an evaluation for autism.

Step 2: Referral from your doctor. TRICARE requires a referral for autism testing.  Your primary healthcare provider will submit a referral to your TRICARE regional contractor.

Step 3: Regional contractor review. In Georgia, TRICARE’s regional contractor is Humana Military.  They will review the referral and connect you with an approved diagnosing provider who can test for autism.  NOTE: You must receive a diagnosis from one of TRICARE’s approved diagnosing providers in order to receive services.

Step 4: Autism testing appointment. TRICARE covers testing done by certain approved specialists.  Testing may include interviews, parent questionnaires, and observation of your child.  NOTE: It may take several months for your child to receive testing.  Places that do autism testing often have very long waitlists.

Step 5: Diagnosis and next steps. If your child is diagnosed with autism, the provider will document it and send the information to TRICARE. Your approved diagnosing provider will also submit referrals for therapies (like speech, OT) as needed.  Importantly, the approved diagnosing provider will send a referral for your child to Autism Care Demonstration and a pre-authorization for ABA services to your TRICARE (Humana Military for Georgia).

NOTE: After diagnosis, you will get an authorization letter from Humana Military. The authorization letter you receive will be for six months of ABA services.  Your child’s ABA providers will need to request a re-authorization every six months.  Please note, the six-month authorization is not the same thing as saying the child is limited to six months of ABA.  There is no annual or lifetime cap on clinically necessary and appropriate ABA under the Autism Care Demonstration.

NOTE: ABA services are only available in locations where TRICARE-authorized Board Certified Behavior Analysts (BCBA) operate.

At this time, you will also be asked to complete four baseline outcome measures before your child can access ABA services.  The goal of these measures is to monitor your child’s progress once they begin ABA.  The four measures are: 1) the Pervasive Developmental Disorder Behavior Inventory, 2) the Vineland Adaptive Behavior Scale, 3) the Social Responsiveness Scale, and 4) Parent Stress Index or Stress Indes for Parents of Adolescents.  You will need to complete these measures every 6- or 12-months, depending on the measure.

For more information on getting an autism diagnosis while in the military, click here!

Autism Care Demonstration: How to Access Early Intervention Services

Autism Care Demonstration (ACD) is a TRICARE program that covers applied behavior analysis (ABA) services.   ABA is a scientifically tested treatment that is often recommended for autistic children.  You can read more about ABA here!  The requirements for enrolling in ACD are:

How Do I Apply for Autism Care Demonstration?

Step 1: Get an autism diagnosis from an approved provider: Your child must have an autism diagnosis from a TRICARE-approved diagnosing provider to receive ABA services through ACD.

Step 2: Complete the ACD referral and preauthorization process: If your child receives an autism diagnosis from the approved diagnosing provider, the approved diagnosing provider will send a referral for ABA services to your TRICARE regional contractor (in Georgia, this is Humana Military). At that time, you can enroll your child in Exceptional Family Member Program (EFMP) and Extended Care Health Option (ECHO):

• Exceptional Family Member Program (EFMP). EFMP helps military families with special medical or educational needs by offering family support, respite care, and relocation assistance to make sure your family is placed where your child can get needed services.
• Extended Care Health Option (ECHO), which provides financial assistance to service members or service member’s family who have special needs.
• To enroll in EFMP, use the resources here. To enroll in ECHO (if you are in Georgia), use the resources here.

Step 3: Wait for your authorization: TRICARE will review the referral and preauthorization request. If your child is approved for the ACD, you will receive an authorization for ABA services.  If approved, you will receive an ABA authorization letter for 6-months of ABA.  As a note, the initial ABA authorization is generally for six months.  However, that does not mean that your child can only receive six months’ worth of ABA.  If ABA continues to be medically necessary and appropriate, the provider can request reauthorization for additional six-month periods.

Step 4: Get an Autism Services Navigator: Once you have received your authorization letter, TRICARE will assign your child an autism services navigator (ASN). The ASN is a licensed mental health professional or a registered nurse with experiences in care management who will work with you to develop your child’s comprehensive care plan (CCP).  The CCP will describe:

• Your child’s strengths and areas where they need support
• Skills your child may benefit from learning
• The services your child may need
• The providers involved in your child’s care
• Your family’s goals and priorities
• Plans for important transitions, such as starting school or moving to a new location

Step 5: Find an ABA Provider: Your ASN will help you find an ABA provider (may be listed in your authorization letter). This is called the active provider placement process.

The availability of ABA providers can vary by location.  TRICARE can only provide ABA services in areas where appropriate TRICARE-authorized providers are available.

If you have difficulty finding a provider, talk with your ASN or TRICARE regional contractor.

Step 6: Complete the ABA Assessment: Once an ABA provider has been identified, the provider will schedule an initial assessment. TRICARE has a 28-day specialty-care access standard.  That means that if your child is not offered an ABA appointment within 28 days, you will need to contact the regional contractor.

During the intake assessment for ABA, a Board Certified Behavior Analyst (BCBA) will work with your child to identify skills that you child struggles with and then create a plan to teach them new skills or treat bad behaviors (hitting, biting, etc…).  The BCBA will use this information to develop an individualized treatment plan.

Step 7: Complete your child’s Comprehensive Care Plan: Your child’s ABA assessment information will be used to develop or update the Comprehensive Care Plan (CCP). Remember: The CCP is meant to be a living document that should change with your child’s needs.  Because of that, the CCP will be reviewed every six months to check your child’s progress and update the treatment plan.

Step 8: Begin ABA and monitor your child’s progress: Once the required approvals and assessments are complete, your child can begin ABA services according to the treatment plan.

TRICARE requires families to complete several standardized measures while receiving ABA as a way of monitoring the child’s progress.  These may include measures of adaptive behavior, social responsiveness, and parent stress.

Source: Steps for ABA Services – provided by TRICARE

Glossary

ACD – Autism Care Demonstration, a TRICARE program that covers applied behavior analysis (ABA) services

ABA – Applied Behavior Analysis, a therapy for autism

EFMP – Exceptional Family Member Program, a program that helps military families with special medical or educational needs

ECHO – Extended Care Health Option,

ASN – Autism Services Navigator, a licensed behavior professional or nurse who will work with your family to develop and maintain your child’s Comprehensive Care Plan (CCP).

CCP – Comprehensive Care Plan, a personalized plan that outlines the child’s challenges and therapies

Approved Diagnosing Provider – Primary care physicians in family practice, pediatricians, pediatrics nurse practitioners; or licensed clinical psychologists, doctors of nursing practice, developmental pediatricians, pediatric neurologists, or adult or child psychiatrists.

BCBA – Board Certified Behavior Analyst, behavioral health professionals who create treatment plans for autistic children.

Active provider placement process – the process of matching an autistic child with an ABA provider.

Article by: McKenzie Clark and The Autism ToolKit

Sources

Autism Care Demonstration. TRICARE. (2025, May 23). https://www.tricare.mil/Plans/SpecialPrograms/ACD

Autism Spectrum Disorder. TRICARE. (2024, September 17). https://tricare.mil/CoveredServices/IsItCovered/AutismSpectrumDisorder

Autism Care Demonstration.  https://www.tricare.mil/autism?p=1