JOINT BASE LEWIS-McCHORD, WASH. — Lindsey Gandy learned TRICARE was cutting her son’s autism services when her husband, a captain in the Air Force, was deployed to Afghanistan. It was the spring of 2021, and the Defense Health Agency had announced it would no longer cover ABA therapy in educational settings. Her son Kingston, then nine years old, had been attending a year-round school that integrated ABA into the day. He had started to make progress — sitting in a classroom, following directions, building the kind of tolerance for routine that had eluded him for years. Then the coverage disappeared.

Gandy called every ABA provider near Hill Air Force Base in Utah. There were eight. Every single one told her the same thing: they were either dropping their TRICARE patients, refusing new ones, or couldn’t afford to accept TRICARE reimbursement rates. In the first quarter of 2022 alone, 654 behavior analysts terminated their contracts with TRICARE nationwide — triple the rate from the same quarter the previous year.

Gandy’s story is not unusual. It is, according to a congressionally mandated review by the National Academies of Sciences, Engineering, and Medicine published in October 2025, the predictable result of a system that has treated ABA therapy as an experiment for more than a decade — while every other major payer in the country treats it as a medical necessity.

The Demonstration That Won’t End

TRICARE has covered autism services since 2001. But for the past 12 years, it has covered ABA therapy only through the Comprehensive Autism Care Demonstration — a pilot program established in 2014 and currently scheduled to run through December 31, 2028. The ACD was designed to evaluate whether the tiered ABA delivery model was appropriate for TRICARE. In practice, it has functioned as a bureaucratic layer between military families and therapy their children need — requiring extensive paperwork, mandatory assessments, enrollment in the Exceptional Family Member Program and the Extended Care Health Option, six-month authorization cycles, and biennial referral renewals from a TRICARE-authorized diagnosing provider.

The distinction between a “demonstration” and a “basic benefit” is not academic. Under the ACD, coverage rules can change dramatically as the Defense Health Agency evaluates what it considers to be working. In 2021, the DHA eliminated coverage for ABA technicians working in school and community settings, restricted providers from addressing activities of daily living such as toileting and grooming, and introduced new mandatory assessments that families described as burdensome and clinically irrelevant. A DHA spokesperson told reporters that an inability to groom oneself or complete chores were not “core deficits” of autism. Providers and families disagreed.

The 2021 changes prompted a backlash that reached Congress. A bipartisan coalition of 11 House representatives urged the DHA to make ABA a standard TRICARE benefit and eliminate the burdens the pilot imposed on military families. The DHA stood firm. In a response letter, Under Secretary of Defense for Personnel and Readiness Gilbert Cisneros wrote that the agency continued to review ABA research but found “well-documented research gaps” about effectiveness and “an overall low quality” of existing studies.

That position became significantly harder to defend in October 2025.

109,000 Children, One Report, Five Recommendations

The National Academies report, mandated by the FY 2022 National Defense Authorization Act, is the most comprehensive independent review of TRICARE’s autism coverage ever conducted. The committee reviewed the scientific literature, analyzed TRICARE claims data, and heard testimony from researchers, providers, and military families. Its findings were unambiguous: ABA meets the Department of Defense’s own standards for reliable medical evidence. Current ACD policies place unnecessary burdens on families and providers. The demonstration should end.

The report’s five core recommendations are: discontinue the ACD and authorize ABA as a basic TRICARE benefit; eliminate mandatory assessments that do not support individualized treatment planning, including the PDDBI, Vineland-3, and SRS; reduce administrative barriers that limit access to ABA services; make Autism Services Navigators and caregiver training optional rather than mandatory; and align TRICARE ABA coverage with clinical best practices, including allowing services to address activities of daily living and enabling therapy in homes, schools, and communities.

More than 109,000 TRICARE-eligible children received an autism diagnosis between 2018 and 2023. The prevalence of autism among military families may be slightly higher than in the general population — approximately 3.5% to 4.5% compared to 3.2% nationally — though the estimates are drawn from different methodologies. What is not in dispute is that these families face structural barriers to care that their civilian counterparts do not: mandatory EFMP enrollment, ECHO registration, assessment requirements that commercial insurers do not impose, and a provider network shaped by military geography rather than clinical need.

Every Move Resets the Clock

The permanent change of station — PCS — is the defining structural challenge of military life for families with autistic children. Military families relocate every two to three years on average. For a child receiving ABA therapy, each move means finding a new TRICARE-authorized provider, completing a new authorization cycle, transferring assessment records, and often waiting weeks or months before therapy resumes. The child’s treatment plan may be designed for one clinical environment and be irrelevant in the next. The behavior technician who has built rapport with the child is gone.

TRICARE coverage technically moves with the family. In practice, the administrative requirements reset at each duty station. Families must maintain EFMP enrollment, ensure their ECHO registration transfers cleanly, and navigate a new regional contractor’s authorization process. If the new location has no TRICARE-authorized ABA providers within access standards, the family faces a gap in coverage that no amount of paperwork can solve. And unlike civilian families, military families cannot choose to stay where the provider is.

Kristi Cabiao, a family doctor and military spouse whose seven-year-old son has autism, founded Mission Alpha Advocacy after the 2021 ACD changes. Parents come to her with stories that follow a pattern: treatment plans denied because they include daily living skills, children losing community-based therapy that had driven real progress, reauthorization processes that consume hours of parental time for no change in services. When her own son lost access to ABA support in community settings, his behavior in public regressed to the point where she could no longer take him to the grocery store.

The Fraud Question and the Evidence Question

The DHA has repeatedly cited fraud concerns as a justification for maintaining the ACD’s oversight framework. A 2017 inspector general report identified billing for services never rendered and falsified documentation within the program. Those findings are not in dispute. But the NASEM committee found that the DHA’s response — additional assessment requirements, more restrictive service settings, and tighter authorization protocols — imposed burdens on all families to address misconduct by a subset of providers. The assessments the DHA required, particularly the PDDBI, were being used to measure program effectiveness in ways the assessment’s own creator said were inappropriate.

In 2018, the DHA’s annual report to Congress stated that ABA did not appear to be effective for most of its patients. Advocates and providers challenged that conclusion, noting that the data relied on the PDDBI — an assessment not designed to measure ABA treatment outcomes. The National Coalition for Access to Autism Services went to the PDDBI’s creator, Dr. Ira Cohen, who confirmed that the instrument was being misapplied. That finding helped drive the congressional mandate for the NASEM review, which ultimately confirmed that ABA is effective for TRICARE patients at rates comparable to commercially insured and Medicaid populations.

2028 Is Coming. Nothing Is Guaranteed.

The ACD is set to expire on December 31, 2028. There is no clear path forward for what replaces it. If the DHA adopts the NASEM recommendations, ABA becomes a basic TRICARE benefit — covered like speech therapy, occupational therapy, or physical therapy, without the demonstration’s assessment requirements, enrollment prerequisites, or setting restrictions. If the DHA does not act, families face the possibility that coverage will lapse entirely when the demonstration ends, or that a new demonstration will be established with its own set of rules, requirements, and disruptions to care.

The DHA’s response to the NASEM report has been measured. The agency told Military Times it is “carefully reviewing the entire report, including the recommendations, to determine our way forward.” Advocates note that the review process tends to move slowly. The FY 2026 NDAA includes provisions enhancing TRICARE access and mental health care, and the House Armed Services Committee has signaled continued interest in autism reform. But no legislative provision has yet mandated implementation of the NASEM recommendations.

Meanwhile, the broader Medicaid crisis — the One Big Beautiful Bill Act’s $1 trillion in cuts, state-level ABA rate reductions, provider network contractions — is compressing the pool of ABA providers available to any payer. TRICARE families are not insulated from that contraction. When providers leave the Medicaid network, they do not necessarily shift capacity to TRICARE. When states cut reimbursement rates below the cost of service delivery, providers exit the market entirely. The TRICARE provider desert grows wider by the same forces driving the civilian access crisis — and military families, who cannot choose where they live, absorb the consequences with less control than anyone.

What Military Families Should Know Right Now

The ACD is still active. ABA services remain available through the Autism Care Demonstration through December 31, 2028. Authorization cycles remain six months. Referrals require renewal every two years from a TRICARE-authorized ASD-diagnosing provider. There are no age limits and no time limits on services under the ACD.

EFMP and ECHO enrollment are still required. Active duty families must be enrolled in the Exceptional Family Member Program and registered in the Extended Care Health Option to access ABA services. The NASEM report recommends eliminating these prerequisites, but that recommendation has not been implemented.

Plan for PCS transitions early. Notify your current ABA provider and TRICARE regional contractor as early as possible before a move. Request records and assessments be transferred. Research provider availability at your next duty station before you arrive. If no TRICARE-authorized ABA providers are available, contact your regional contractor for placement assistance.

Know your advocacy channels. Organizations including Mission Alpha Advocacy, the National Coalition for Access to Autism Services, MOAA, and the Council of Autism Service Providers are actively advocating for implementation of the NASEM recommendations. Contact your congressional representatives through the Armed Services Committees to support legislation that would mandate ABA as a basic TRICARE benefit.

The American military asks families to move every two to three years, to absorb deployments that last months, to live where they are told to live and access whatever health infrastructure exists when they get there. In return, it promises world-class health care. For the more than 109,000 families whose children carry an autism diagnosis, the promise and the reality diverge at the point where a pilot program enters its twelfth year, a provider hangs up the phone, and a mother decides she can no longer take her son to the grocery store. The NASEM report says the system is broken. The evidence supports making ABA a basic benefit. What remains is the part that has always been hardest in Washington: doing the thing everyone agrees should be done.

AT A GLANCE

Sources & References

1. National Academies of Sciences, Engineering, and Medicine. “The Comprehensive Autism Care Demonstration: Solutions for Military Families.” October 24, 2025

2. The War Horse. “US Military Kids With Autism Lack Treatment Under Tricare.” October 19, 2023

3. MOAA. “Report Backs Long-Sought Changes to TRICARE Autism Programs.” September 22, 2025

4. Healthcare Innovation Group. “New Report Shows Military Families Are Being Denied Autism Care.” October 2025

5. Fox San Antonio / KABB. “Congressional Committee Pushes for Tricare Overhaul to Aid Military Families with Autism.” September 20, 2025

6. Butterfly Effects. “NASEM Recommends Expanding TRICARE Coverage for ABA Services.” October 22, 2025

7. Council of Autism Service Providers. “National Academies Report Endorses Autism Community’s Recommendations.” October 3, 2025

8. Congressional Research Service. “Defense Health Primer: TRICARE Comprehensive Autism Care Demonstration.” IF12345, March 2023

9. TRICARE. Autism Care Demonstration Questions & Answers. tricare.mil (accessed March 2026)

10. TRICARE. ABA Service Locations. tricare.mil (accessed March 2026)

11. Frank Porter Graham Child Development Institute / UNC. NASEM Report Release. October 2025

12. Autism Speaks. “Policy Pulse: Federal Budget, White House Updates & TRICARE Reform.” 2025