Establishing health care is challenging for all Americans. Waitlists are long and costs are high. But for military personnel whose families are enrolled in the military’s Exceptional Family Member Program (EFMP), the process of finding care also impacts where their detailers will send them.
“My child was not diagnosed with apraxia until they were 13, when we finally said, ‘forget it. We’re done with the military medical system,” Navy spouse Tonya Murphy shared with me and the other guests of Military Dinner Table Conversations, monthly reverse town halls I hold to better understand topics that impact recruitment and retention. That month, we were talking about EFMP.
“I advocated for my child,” said Murphy. The Murphy family had been stationed overseas with the Navy from the time their son was four until he was nearly ten years old. She knew something was wrong.
“Listen, this kid’s really bright, but their speech isn’t quite there. And there’s something going on, and there’s something going on and there’s something going on, and no one even tried to find an answer until, in some ways, it was too late.”
What EFMP Is Supposed to Do
EFMP has three primary functions: identification and enrollment, assignment coordination, and family support programming. If a service member’s spouse or child has a qualifying medical diagnosis that is identified by a military doctor or is self-reported, those family members are automatically enrolled in the program.
The program’s goal is to identify and address the needs of military families throughout their time in the military. However, stories like Murphy’s are not singular.
When Cara-Lee Alford’s son was three years old, he was experiencing headaches, falling down, and losing previously achieved skills like speech. His doctors began testing, but because Alford’s spouse was up for orders, they moved before he received a diagnosis.
“They didn’t tell me it was an option to say, ‘Hey, I don’t want to move until we get this stabilized,” said Alford, whose spouse served in the Air Force before transitioning to the Space Force. It took two months for him to be seen by his primary care doctor in the D.C. region, where they finally got a referral to see a neurosurgeon who recommended surgery. The surgery took place three months later.
“This kid was living with these incredible headaches, but that was just his life,” Alford shared. “I’m tearing up, because what it’s like to see that difference when he didn’t have the pain.” Finally getting surgery was a relief for Alford, whose son struggled to get care every step of the way.
“They kept sending us to providers that weren’t in this system,” she shared. “This one doesn’t take Tricare. This one isn’t actually a developmental pediatrician.”
Alford reported having spent six hours on the phone with Tricare trying to obtain a single referral and was ultimately unsuccessful, having to make additional calls before finally receiving it a year later. She said it was a regular occurrence to have to tell Tricare to update their system, and that the same three providers they were sending her to couldn’t help her son.
Delays in obtaining a diagnosis and bureaucratic headaches are not the only aspects of EFMP that families report are falling short of expectations. The other is assignment coordination.
Is EFMP Assignment Coordination Helping Families?
When Jennifer Bittner’s husband was selected for battalion command at Fort Sill, Oklahoma, their family should have been happy, but she knew that as her husband moved up in rank, getting care for their three medically complex children would become more difficult in this remote location.
When they asked EFMP if their family was cleared for this location, they were told that “big Army did a general clearance,” and they were told to reach out to the local EFMP office. Bittner shared that when they spoke to the local office, it was clear that the local area could not offer the medical services their family needed.
“So I went ahead and I had to research not only Fort Sill, but all the other basic training battalion locations, in case they came back and said, ‘Oh, well, you can go to Fort Leonard Wood, Fort Jackson.’ So I looked all of them up,” said Bittner. Like many other EFMP families, she wasn’t trying to fly under EFMP’s radar. She wasn’t hiding her child’s diagnosis to get an assignment in Europe.
“We’ve never tried to go anywhere that we can’t go,” said Bittner.
“[Detailers] select the location and then ask if you can go there,” said Austin Carrigg, CEO and founder of the nonprofit Exceptional Families of the Military (EFM), an organization she founded to help correct the gaps in EFMP service her family had experienced. “We’re just hearing a lot of families are getting nos to places that they say they can find care,” said Carrigg. “So the family, they’re saying, Oh, I’ve found the care, but they’re telling us that care is not available.”
It is not surprising that EFMP offices are having a hard time keeping up-to-date with care availability. Research says children with special health care needs are four times more likely than other children to experience gaps in medical care.
However, once care is established, civilian families do not have to reestablish care at the rate military families do, making EFMP essential to ensuring the continuity of medical care for these military families.
According to a 2022 DoD EFMP survey, more families than not were dissatisfied with the assignment coordination process, with only 33 percent reporting satisfaction and 40 percent expressing dissatisfaction.
Improvements Are Coming, Slowly
But Carrigg reports there are positive changes in the works.
“In this year’s NDAA, that hopefully passes, they’re going to change TRICARE PRIME travel to a 50-mile radius instead of a 100-mile radius,” shared Carrigg. If this passes, EFMP families may still have to travel to find the care they need, but this time they will be reimbursed for their travel, allowing them to more confidently accept duty assignments with limited care. “At least if they’re having to drive a significant distance over 50 miles, they’ll get TRICARE Prime travel. And I feel like that could mean something to so many people.”
But until more policies change, some families will likely continue to question the value of EFMP.
“Y’all still tried to send us somewhere where you knew we were going to get rejected,” said Bittner. “It just makes me sad, because our families would be very, very loyal to the military if the military just did its job and took care of us.”
