Fix the Gap: Terminally Ill Military Kids Must Forego Treatment to Receive Hospice Care

Treatment or Hospice

Your family sacrifices 365 days a year. You endure multiple moves, silently serve during repeated deployments, and patiently wait through the dreaded appointment line to receive care at your Military Treatment Facility. You expect your TRICARE benefit to be there for you when you need it most.

Since the Affordable Care Act (ACA) was passed, our Association has worked to ensure TRICARE policies are on par with coverage mandated by the ACA. Given the sacrifices service members and their families make, shouldn’t military families expect health care comparable to that offered by commercial plans and Medicaid? 

We think so.

We’ve recently become aware of a TRICARE coverage gap related to medical care and services for terminally ill military kids—a gap so appalling we believe it must be fixed immediately.

When a person is terminally ill and near the end of life, they often receive hospice care. Hospice is the gold standard for end of life care and includes pain management and symptom control, as well as counseling and emotional support for the patient and their family. Terminally ill adults who are covered by Medicare and other insurance plans usually must agree to give up coverage for curative care (care to overcome disease and promote recovery) in order to be eligible for hospice.

But kids are different. Life-limiting conditions in children can be unpredictable. The guidelines used to make adult hospice decisions don’t apply. For that reason, the ACA requires all state Medicaid programs to pay for both curative care and hospice services for terminally ill children. 

But TRICARE will not pay for a terminally ill child’s hospice services unless the parents agree to give up coverage for further curative care.

This is unacceptable. 

It’s NOT reasonable to expect parents to agree to forego treatments for a child’s condition in order to access hospice care.

The ACA recognized that requiring parents to forego curative care for terminally ill children is not rational and fixed Medicaid to allow kids to receive hospice care while also being treated for their illness. Now it is time for TRICARE to make a similar policy fix to make sure terminally ill military kids can access hospice services.

NMFA is working with the TRICARE for Kids Coalition to encourage the Defense Health Agency to review TRICARE’s pediatric hospice policy. We believe the Defense Health Agency may have the authority to bring TRICARE’s policy in line with ACA requirements for concurrent hospice care for children.

If not, NMFA is committed to working with the TRICARE for Kids Coalition to pursue a legislative fix.

Military families must be allowed to access to the appropriate end-of-life services for their terminally ill children without being forced to give up on future curative care.

Posted November 8, 2016


From: Megan on: November 8, 2016
This is definitely wrong! Not only is TRICARE's policy outdated given the current legislation, it is immoral. How can they ask parents to make this choice? They are CHILDREN. I realize there are boundaries to what TRICARE can reasonably expect to cover however, this coverage for children should be comprehensive, PERIOD. Terminally ill children represent such a minute segment of TRICARE customers that this should be a non-issue. What can we do as beneficiaries to push for this change??
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