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.
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:
*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).
ADFMs may be eligible for additional programs and services such as EFMP and ECHO.
ECHO provides supplemental coverage to ADFMs beyond what is offered under the TRICARE Basic Program. ECHO services may include:
To receive the TRICARE ECHO benefit, beneficiaries must receive ASD diagnosis, enroll in the EFMP and register with Humana Military in the East Region.
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:
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:
Case management services are available to TRICARE ASD beneficiaries and include:
To enroll in the case management program, talk to your provider about a referral or contact us at (800) 444-5445.
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.
