Defense Health Care

Disability Programs Need Improvement and Face Challenges Gao ID: GAO-02-73 October 12, 2001

The military's health program--TRICARE--provides medical care to about 8.3 million active duty service members and retired beneficiaries and their dependents and survivors. The Department of Defense (DOD) also provides benefits for persons severely disabled by physical or mental problems through its Individual Case Management Program for Persons with Extraordinary Conditions (ICMP-PEC) and for less severely disabled active duty dependents through its Program for Persons with Disabilities (PFPWD). Recently, military families and advocacy groups have raised concerns about accessing ICMP-PEC benefits. Also, the DOD Authorization Act for 2001 entitled military retirees age 65 and older and their dependents and survivors to TRICARE benefits for life which may have caseload and cost effects on ICMP-PEC. As of June 2001, 38 ICMP-PEC participants were projected to receive $6 million in services in fiscal year 2001, Their annual per-case costs were projected to range from $13,000 to $382,000. ICMP-PEC now lacks a clear purpose, well-defined eligibility criteria and benefits, and an efficient application process. In contrast, PFPWD is an established program with well defined criteria and benefits that assist thousands of ADFMs with their special health care service and equipment needs. Also, before April 2001, PFPWD provided many services and equipment at modest cost to ADFMs with severe disabilities that were also available at higher copayments to less seriously disabled ADFMS under TRICARE Basics. Data are unavailable on how many PFPWD participants are affected by the program's $1,000 monthly benefit limit. A comparison of ICMP-PEC's home care benefit of up to 24 hours of skilled nursing care per day, seven days per week-and unlimited skilled nursing facility coverage with Medicare and selected Medicaid programs showed that ICMP-PEC's benefits are more generous.

Recommendations

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