Military families rely on a complex health care system integrating direct care from military treatment facilities (MTFs) with purchased care from civilian providers in the TRICARE network. The mix of direct and purchased care varies by installation, so these families often face a vastly different military health system (MHS) from one duty station to the next.

This complex, inconsistent setup comes with enduring access to care challenges. “Timely access to care has been a long-standing problem in the military health system,” according to last year’s report from the House Armed Services Committee’s Qualify of Life Panel.

Helping military families overcome these issues and keep access to their service-earned care has long been a top legislative priority for MOAA. In the 119th Congress, we will aim to secure a digital access assistance system that would allow beneficiaries to report these challenges.

A digital system would provide two key benefits: It would route beneficiary access issues to the appropriate contact for help navigating the MHS, and it would improve MHS oversight and accountability by providing visibility to patient access problems so fixable issues can be addressed.

The need for such a system has never been more obvious. DoD officials have acknowledged the MHS is destabilized and can’t always provide timely access to medical care. Typical MTF appointment shortages have been magnified by U.S. health care workforce volatility and the realignment of uniformed medical personnel as directed by Congress. This has led to MTF staffing shortages and a surge of patient complaints, as reported by a November 2023 DoD Inspector General management advisory.

DoD’s strategy to stabilize the MHS acknowledges MTFs cannot always deliver timely care to patients, yet it puts forward plans to return 7% of beneficiary care to MTFs from the TRICARE network of civilian providers.

TRICARE’s annual enrollment policy further complicates access and can trap TRICARE Prime families in MTFs that don’t meet their needs. Patients with MTF access problems can’t simply change TRICARE plans to move their care to civilian providers – they must wait until the annual open season or a qualifying life event (QLE) such as a geographic move. While commercial health plans lock beneficiaries into coverage levels, TRICARE’s annual enrollment can lock beneficiaries into a single medical facility – making an effective reporting and resolution system vital to patients who can’t seek care elsewhere.

MHS destabilization, together with TRICARE policies that restrict access to the civilian network, demand better options for reporting access challenges.  

[RELATED: MOAA’s TRICARE Guide]

MOAA has developed bill text, modeled off legislation for the VA’s Patient Advocate Tracker Act, that would require DHA to establish an information technology system allowing beneficiaries to electronically file a complaint related to access to care and view the status of the issue – including actions taken by the patient advocate or MTF leadership. The system also must enable MTFs to regularly report to DHA and Congress on patient-reported problems so systemic issues can be addressed.

This technology will help beneficiaries nationwide not just by ensuring they receive the right support for their individual problem, but by identifying problem areas throughout the MHS and by improving the oversight capabilities of DHA and elected officials. Advocacy groups like MOAA will benefit from the data such a system can provide – by understanding what types of problems beneficiaries experience, we can direct our resources toward finding needed solutions.

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