A recent article published by Military.com gives us the first look at the Defense Health Agency’s plan to move approximately 200,000 military family members, retirees, and their families and survivors into the TRICARE civilian network.

Congress directed this rightsizing of the direct care system as part of comprehensive Military Health System (MHS) Reform legislation included in the FY17 NDAA. Specifically, Sec. 703 of the legislation required DoD to develop an implementation plan to restructure and realign military treatment facilities (MTFs). The congressional intent of these changes is to sharpen focus of the MHS on readiness of both operational forces and the medical professionals who support them.

To improve the readiness focus, Congress has directed DoD to eliminate care that doesn’t contribute to the readiness mission and move it into the TRICARE civilian network. Other provisions in the FY17 NDAA direct DoD to develop additional partnerships with civilian medical centers to provide more trauma care opportunities and potentially open MTFs to veterans or civilians who have medical cases that support the key skills needed for combat casualty care.

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The Sec. 703 report on restructuring MTFs has been in development for about three years, and we understand it is due to be released any day.

Military.com obtained a memo sent to MTF commanders in advance of the Sec. 703 report release. The memo details the impacts of the proposed MTF restructuring. Highlights of the restructuring include:

• 50 hospitals and clinics will be impacted. Services at 48 MTFs will be reduced while two MTFs may be expanded. The memo did not include a list of locations that will be affected.
• At 38 outpatient clinics, DoD recommends reducing the scope of MTFs to serve only active-duty servicemembers, while in many cases maintaining pharmacy services for all beneficiaries.
• It is estimated that approximately 200,000 beneficiaries who receive care at the MTFs identified for reduction in operations will transition to civilian providers in the TRICARE network. Based on TRICARE enrollment data included in the FY19 Annual Evaluation of the TRICARE Program Report to Congress, MOAA believes this represents about 10% of the 1.95 million TRICARE Prime beneficiaries (not including active-duty servicemembers) enrolled to military primary care managers.

Many beneficiaries are concerned about the impact on their out-of-pocket costs. Active-duty family members would continue to receive covered services from network providers with zero copays provided they follow TRICARE referral and authorization requirements. TRICARE Prime retirees and their family members transferred from MTFs to TRICARE network care would face out-of-pocket cost increases since they would now incur copays for most care until they hit the $3,000 annual catastrophic cap (i.e., maximum out of pocket) for covered services.

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After reaching the catastrophic cap, there are zero copays for covered services from network providers.

Although we have been told nothing is changing immediately, we have already been contacted by families who have been notified they are being transitioned to civilian care. Changes to the MTF scope of services will be implemented over a two- to five-year timeframe. Patients will not be transferred from MTFs until DHA is able to confirm there are available providers in the TRICARE network.

We appreciate the objective of this restructuring is to increase the focus on military and medical force readiness, but we also know how this news must appear to military families and retirees. Many fear they will be pushed out of military hospitals and clinics into a civilian medical system that lacks capacity and is not prepared for an influx of new patients.

TRICARE Prime retirees and their families have the added worry about how new out-of-pocket costs for civilian health care will impact their household budgets, particularly given the TRICARE copay increases that went into effect in 2018.

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The memo to MTF commanders emphasized that no care will be moved out of MTFs until civilian providers are identified, but there are many more factors to consider.

At this point, the only information we have is based on access to a memo from DHA to MTF commanders. MOAA has been told the Sec. 703 report, with detailed MTF realignment implementation plans, will be released by Feb 14. We are standing by to review the report to ensure DHA has conducted a thorough analysis and developed mitigation plans regarding any MTF care to be eliminated and moved to the TRICARE network.

For any areas of concern identified, we will assess whether our best next step is to leverage relationships at DHA and the services to address the issue or pursue congressional engagement. Throughout this process, please be assured MOAA’s focus is protecting the military health benefit for service members and retirees, their families, and survivors.