These are some of the "Casualties of TRICARE" Issues Presented during our visit to DC, and for which we seek an acceptable resolution! |
** I made sure to let them know that this was a global problem involving numerous families within the military - active and retired. ** The definition of "custodial" under Tricare's definition is a serious problem, and the fact that it is contradictory in that a person can have both skilled medical needs and custodial ** The current definition of "custodial" under Tricare/DOD's definition is affecting military families globally, and it is contradictory in that a person can have both skilled medical needs and custodial needs (as defined by other medical programs), and still be found to be completely custodial if the patient is not expected to recover. Plus, it is in conflict with all other federal insurance programs definitions, such as FEHBP, and Medicare. Lastly, their definition had been found to be misapplied in two previous cases by a federal court. ** DOD cost shifting these cases to state Medicaid programs brings about a host of problems during change of command and accessing care in different states - since most of us don't qualify for these programs due to the improper way that most federal and state agencies apply military allowances as "unearned income" which disqualifies us from falling within income restrictions. Plus, the problems accessing medicaid waivers, including waiting lists and lack of funding which causes many states to simply not have waiver slots available, or very lengthy waiting lists. A waiting list is useless, if you are dealing with life-sustaining care. ** It is simply more cost effective (not to mention ethical and humane) to provide better care at home for these long-term, medically involved individuals because they usually required less inpatient services, such as hospitalizations, and ER visits, etc, when they received skilled medical care at home. Plus, the Americans With Disabilities Act was established in part to provide that disabled individuals were not only entitled, but should be encouraged, to remain at home vs. institutionalized, where they would be more comfortable and treated with a greater degree of respect and dignity. ** The new Case Management Program being offered as the solution to this problem is deceptive, and that it really only meets the needs of those individuals who need hospice type care, or short-term rehabilitation. I pointed out to various officials that I thought it was a tremendous program for those type of cases where there is not a long term prognosis - but a 365 day cap for the rest of us essentially made the program completely useless. ** EFMP is completely useless!!! (Senator McCain's office in particular found this issue distressing, and I got a vow from Christopher, his military affairs staffer, to look into this problem personally! In fact, I ran into him again at the NMFA reception being held that week, and HE brought it up again!) ** With military moral being at an all-time low, and enlistments being consistently down, the effect this lack of support from the DOD has on our active duty men and women who are the backbone of this nation, and this government, is vast. I appealed to their patriotism, (especially since I am a very patriotic person myself this was easy for me), and asked what happened when we could no longer turn to our own "military family" for support during these difficult times. It was perfect because at the NMFA reception, Senator Warner was making a speech and addressed this "military family" concept in it, but it was AFTER I had been doing it all over the place all week long on the Hill. ** Finally, I reminded those in positions of influence that the Defense Appropriations Committee, recognizing this inequity, attempted to rectify this custodial care definiton problem by adding language to the HR Defense Appropriations Bill for the Fiscal Year 2000, which changed the definition of Custodial care to be in accordance with other federal programs. I asked for their support in making sure the change was made permanent by adopting it in the Senate version, and enacting it through the Defense Appropriations ACT this year. |
