National Academies Urges Permanent TRICARE ABA Coverage

What the Report Recommends

WASHINGTON – A congressionally mandated review has concluded that applied behavior analysis meets the Defense Department’s own standards for reliable medical evidence and should be authorized as a permanent TRICARE benefit, rather than continuing under the temporary demonstration that has governed military ABA coverage for more than a decade.

The report, The Comprehensive Autism Care Demonstration: Solutions for Military Families, came from the National Academies of Sciences, Engineering, and Medicine and was released in 2025. Congress ordered the independent analysis in the fiscal 2022 National Defense Authorization Act, Section 737, after years of complaints from military families about access under the demonstration. The 336-page study recommends that the Defense Health Agency discontinue the Autism Care Demonstration and fold ABA into the basic TRICARE benefit.

The committee did not stop at coverage. It called on the agency to drop assessment requirements that do not inform treatment, give clinicians more flexibility in treatment goals and settings, make parent training and autism service navigators optional rather than mandatory, and approve the full set of CPT (Current Procedural Terminology) billing codes the industry uses. It also recommended moving ABA off the military health system’s No Government Pay List, the roster of services TRICARE will not pay for as a standard benefit.

“This report is a watershed moment for our military families.” – Mike Moran, Chairman, National Coalition for Access to Autism Services (2025)

Why Demonstration Status Matters

ABA has reached military families through a demonstration since the current program took shape in 2014, and that structure is the source of the uncertainty. By law, TRICARE covers only services the Defense Department determines to be medically or psychologically necessary as part of its permanent benefit. The department has never made that determination for ABA, so the therapy runs on demonstration authority, a temporary footing the Pentagon and Congress renew and revise rather than treat as settled. Offering ABA as a permanent covered service would require that medical-necessity finding, the Congressional Research Service has noted, which is the determination the new report directly supports.

The demonstration is currently authorized through 2028, and its terms change often. TRICARE overhauled the program in 2021, adding assessment and documentation requirements that drew years of family complaints and prompted the very review the National Academies has now delivered.

The military program is also an outlier among large payers. Nearly all commercial and self-funded employer plans, Medicaid, the Children’s Health Insurance Program, the Federal Employees Health Benefits Program, and CHAMPVA cover ABA as a standard benefit, the National Coalition for Access to Autism Services noted, while TRICARE still treats it as a temporary demonstration. About 17,300 children received ABA through the program in fiscal 2022, by the Congressional Research Service’s count, and the report found that more than 109,000 TRICARE-eligible children were diagnosed with autism between 2018 and 2023.

What Clinics Near Bases Face

For providers clustered around military installations, TRICARE referrals are a core part of the caseload, and the demonstration’s impermanence shows up in contracting and staffing decisions. Coverage that has to be renewed and rewritten is harder to build a hiring plan or a lease around than coverage treated as settled.

The instability is not theoretical. TRICARE moved to new regional contracts on January 1, 2025, with Humana Military running the East Region and TriWest Healthcare Alliance taking the West. ABA providers had to sign new participation agreements by December 1, 2024 or lose the ability to bill for services, and some practices reported unpaid claims and credentialing delays through the transition.

Reimbursement has shifted as well. TRICARE revised its ABA Maximum Allowed Amounts, the ceilings it pays for the main ABA billing codes, on May 1, 2025. The sensitivity of those rates is well established. When the Defense Health Agency cut ABA reimbursement in 2016, a bipartisan group of senators warned the Secretary of Defense that providers would leave the TRICARE market before military families could find replacements.

For a clinic built around military referrals, the gap between a demonstration and a benefit is the gap between coverage that must be renewed and coverage that can be planned around.

Advocates and providers argue that permanent status would change that math. A basic benefit would give clinics reimbursement they could plan around, could draw more providers into a network that has struggled to keep them, and would set a federal precedent other payers watch. The report does not promise those outcomes. It makes the clinical and evidentiary case that ABA belongs in the permanent benefit and leaves the operational consequences to follow.

The Path to a Permanent Benefit

Recommendations are not policy. The decision now sits with the Defense Health Agency, which told Military Times it is reviewing the report “to determine our way forward with the Autism Care Demonstration.”

Acting on the findings would require the department to make the medical-necessity determination it has avoided, then move ABA off the No Government Pay List and write the rules for a permanent benefit, a sequence that runs through federal rulemaking rather than a single announcement. Congress, which created the demonstration and ordered the review, could also direct the change through a future defense authorization bill, as it has directed nearly every prior shift in military autism coverage.

The demonstration’s current authorization runs through 2028. Whether the Defense Health Agency converts ABA into a permanent benefit before then, or lets the program run toward its sunset while it deliberates, is the question the report now puts in front of the Pentagon.

AT A GLANCE

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