ACD benefits and programs

TRICARE families with special healthcare needs may need services beyond what is covered under TRICARE’s basic benefit. Discover programs and services available to assist in getting the care you need.

TRICARE benefits and programs

Explore our ABA welcome guide for ACD benefit details, caregiver resources, FAQs and more.

TRICARE covers a full range of medical and specialty care services to address the needs of beneficiaries with Autism Spectrum Disorder (ASD). Coverage for eligible beneficiaries may include the following services:

  • Occupational therapy
  • Physical therapy
  • Physician services
  • Psychological services
  • Psychological testing
  • Prescription drugs
  • Speech therapy
  • Applied Behavior Analysis (ABA)*

*To receive TRICARE reimbursement for ABA, beneficiaries must be enrolled in TRICARE’s Autism Care Demonstration (ACD). ACD enrollment requires all beneficiaries to:

1) Receive an ASD diagnosis from their Primary Care Manager (PCM) or qualified ASD diagnosing provider and

2) Get a referral from their provider and prior-authorization from Humana Military.

Please note that Active Duty Family Members (ADFM) only must also enroll in their service’s Exceptional Family Member Program (EFMP) and register in TRICARE’s Extended Care Health Option (ECHO).

Learn more about ACD

Additional programs for eligible beneficiaries

ADFMs may be eligible for additional programs and services such as EFMP and ECHO.

Extended Care Health Option (ECHO)

ECHO provides supplemental coverage to ADFMs beyond what is offered under the TRICARE Basic Program. ECHO services may include:

  • Training
  • Rehabilitation
  • Special education
  • Assistive technology devices
  • Institutional care (may include transport to and from)
  • Home healthcare
  • Respite care for the primary caregiver
  • Case management and care coordination

To receive the TRICARE ECHO benefit, beneficiaries must receive ASD diagnosis, enroll in the EFMP and register with Humana Military in the East Region.

Learn more about ECHO

Exceptional Family Member Program (EFMP)

EFMP assists ADFMs with special healthcare services at present and new duty stations. The EFMP makes sure special needs are considered during assignments and helps ADFMs access assistance wherever they are. EFMP service include:

  • Offer information about local services and programs, including childcare and relocation assistance
  • Help you apply for benefits and entitlements
  • Connect you with other families with special needs

To enroll in the EFMP, ADFMs must obtain paperwork from the EFMP medical point of contact at their local military hospital or clinic. Find your service branch’s EFMP representative by visiting the installation program directory

EFMP enrollment forms:

Learn more about EFMP

Case management services

Case management services are available to TRICARE ASD beneficiaries and include:

  • Referrals to local or state-funded resources
  • Educational tools and resources focused on the beneficiary’s needs
  • Care coordination
  • Development of individualized care plan to include goals and the different types of care and services to meet the beneficiary’s needs

To enroll in the case management program, talk to your provider about a referral or contact us at (800) 444-5445.

Government assistance

Children and adults with ASD may be eligible for government assistance for help covering the costs of basic living needs such as food, housing and clothing through Social Security or Medicare.