Medicaid Waiver Benefits for Military Families 

When considering medical benefits for family members with special needs, military families often overlook Medicaid, a health benefits program established by federal law. Medicaid covers basic and long-term health care services for eligible children, pregnant women, parents with dependent children, adults aged 65 or older, and individuals with disabilities.

Eligible dependents of military families can benefit from BOTH TRICARE and Medicaid. Since TRICARE and Medicaid are both entitlement programs established by federal law, Congress has established a hierarchy of benefits between the two programs so eligible military family members receive the maximum range of benefits.  When a military family member is dually enrolled in TRICARE and Medicaid, TRICARE is the primary payee and Medicaid covers remaining costs.

Medicaid’s financial eligibility is determined by low-income limits and the number of members in a family. The income limits and coverage vary by the State administering the Medicaid program.  In most states, a person who is eligible for Medicaid is automatically eligible for Social Security Income (SSI). In some states, the application for SSI includes Medicaid, while in others there is a separate application process. Learn more about SSI.   The Division of Disability Determination Services (DDDS) in Washington State is responsible for assessing blindness and disability for SSI and Medicaid eligibility.

State waiver programs vary in eligibility criteria and coverage. The federal Medicaid website contains information Medicaid programs in each state, as well as state waiver programs. Waivers allow the state to decide how to spend federal Medicaid funding. For more information about mandatory benefits states must provide under Medicaid, read this Military OneSource article.

In many states, there are waiting lists for Medicaid waiver programs, and it may take years for an applicant to begin receiving services under the waiver. However, waiting lists are not always first-come, first-served. They can be based on the type and severity of disability, or on availability of providers and services. Each state runs its own Medicaid program, and benefits do not automatically transfer from one state to the next. Military families must reapply to get benefits anytime they PCS to another state.

Recognizing the challenge this presents for highly mobile military families, 37 states have developed policies specific to military families. Military waiver benefits in most of these states, including Washington, allow active duty military families to enroll in a waiver program and remain on the waitlist in their state of legal residence if they move but plan to return to that state. In Florida, there is no waitlist for Medicaid waivers if the active duty military family member was receiving waiver services in the previous state. Families are responsible for keeping their Case Manager informed as to their current location. Changes in status must be reported promptly to the Case Manager. This Military OneSource article provides more information about how to access military waiver benefits. 

When a service member leaves the military and TRICARE benefits change, Medicaid can provide services similar to those of TRICARE Extended Care Health Option (ECHO). Apply for Medicaid benefits for your child in the state in which you will be living after retirement or separation and apply before any transitional period for medical benefits starts. This will help prevent or minimize gaps in services and supports for the military family member with special needs.

Contact your regional TRICARE contractor to answer questions about receiving Medicaid benefits while on TRICARE.

Additional Resources

Exceptional Family Member Program (EFMP), Part 2: How Does EFMP Benefit Military Families?

A Brief Overview

  • This is part of a two-part series on this topic of the Exceptional Family Member Program (EFMP). This article continues from Part 1: What Makes a Military Family Exceptional?
  • EFMP consists of three parts that work together for identification and enrollment, assignment coordination, and family support.
  • An off-site centralized office within the branch of service determines eligibility for EFMP and level of need.
  • Enrollment should be updated when there is new medical or educational information, and at least every three years.
  • EFMP enrollment ensures the family member’s needs are considered in the assignment process, although the military requirements take priority.
  • EFMP Family Support provides nonmedical case management, information, resources, and support.
  • Beginning in 2023, eligible families may access 20-32 hours of EFMP respite care per month through their branch of service, depending on level of need and availability of services.
  • Get the most from EFMP by contacting the installation’s Family Support office for information, resources, and support.

Full Article

The Exceptional Family Member Program (EFMP) is a mandatory program for all branches of the U.S. Armed Forces that helps military dependents with special medical or educational needs. The Army, Navy, Air Force, Marine Corps, and Space Force each have an Exceptional Family Member Program (EFMP). The Coast Guard, which operates under the authority of the Department of Homeland Security, has a similar program called the Special Needs Program (SNP).

EFMP is made up of three parts that work together to provide:

  1. Identification and Enrollment
  2. Assignment Coordination
  3. Family Support

Identification and Enrollment 

This is the entry point for EFMP. When the service member turns in the enrollment forms, they are sent for processing to an off-site centralized office within the branch that will determine eligibility and the level of need. The decisions are made by medical document reviewers who do not meet or speak with the dependents. Upon completion, the servicemember will receive a letter of verification from the EFMP program for their branch of service.

The same office will determine eligibility for TRICARE’s Extended Care Health Option (ECHO) supplemental medical insurance plan.

EFMP enrollment should be updated anytime the family member has new medical or educational information, and at least every three years.

Assignment Coordination

Once a family member is enrolled in the program, personnel and medical departments coordinate future duty assignments with consideration of the family member’s medical or educational needs. Although the family member’s needs are considered in the assignment process, military requirements take priority for assignment decisions. Orders that accommodate the family member’s needs may include:

  • Accompanied assignment only to locations that have services and resources to support the family member’s medical or educational needs.
  • Unaccompanied assignment, in which the servicemember relocates to the new duty station without the dependents, for a shorter duration than standard duty rotations.

If a service member disagrees with the availability or lack of availability of services at their next duty station, Department of Defense (DoD) Instruction 1315.19 (issued June 2023) provides them up to 14 calendar days from the date of the original assignment notification to request a second review and submit updated medical or educational information. A service being “available” does not mean the family won’t encounter a waiting list for these services, providers who are no longer taking clients or patients, or other interruptions in services.

Families enrolled in EFMP should ensure their paperwork is complete and current before assignment and permanent change of station (PCS) to a new duty station. Get ahead of assignment coordination and allow time for updates to be processed by updating the enrollment forms before the servicemember’s window opens for selecting orders.

Enrollment in EFMP does not prevent the service member from deploying or taking an assignment on unaccompanied orders.

Family Support

This is the department that directly serves families with nonmedical case management and support, including:

  • Information about local military and community programs, services, and supports.
  • Partnering with the School Liaison to provide information about early intervention services, special education, and school-based supports for students with disabilities.
  • Assistance with navigating DoD medical, educational, and counseling systems.
  • Local programs and activities for the benefit of families enrolled in EFMP, such as support groups, classes, and regional or installation events.
  • Warm handoffs to EFMP programs and School Liaisons at the next duty station.

Beginning in 2023, EFMP family support providers are required to personally contact each family assigned to their caseload and every family using the respective service’s respite care program at least once annually.

Find your EFMP enrollment or family support. In the drop-down menu for “Program or service”, select “EFMP Family Support” or “EFMP Enrollment”. Then, select your location from the drop-down menu labeled “Location based on”.

Respite Care

Eligibility requirements for EFMP respite care differ by branch of service and availability of services varies by location. The 2023 DoD Instruction 1315.19 standardized the respite care hours to 20-32 hours per month, across all branches of service, depending upon level of need of the eligible family member. It also extended coverage to include adult dependents and added the opportunity for eligible families to request additional services based on exceptional circumstances.

EFMP respite care is not an entitlement program, but a benefit available only to those who qualify. However, families who are ineligible for EFMP respite care may be able to access community-based respite care programs. EFMP respite care is also separate from TRICARE’s ECHO respite and ECHO Home Health Care (EHHC) respite programs, both with their own eligibility requirements.

Getting the most benefit from EFMP

Families enrolled in EFMP can get the most benefit from EFMP by contacting their installation’s Family Support office to:

  • Connect with the Family Support office at the new duty station to facilitate services and supports prior to a PCS
  • Locate resources at the state and local levels, such as civilian respite programs and disability-specific events
  • Identify state and federal benefits for which the enrolled family member may be eligible, such as Medicaid waivers, Vocational Rehabilitation, and scholarships for individuals with disabilities

The DoD developed the EFMP Family Support Feedback Tool as a method for families who have accessed their installation’s EFMP Family Support to provide feedback about their experiences. This information applies to the DoD’s Office of Special Needs’ policy development and program improvements for all branches of services.

Download the EFMP Enrollment Checklist.

Learn More about EFMP

This is part of a two-part series on this topic of the Exceptional Family Member Program (EFMP). This article continues from Part 1: What Makes a Military Family Exceptional?

STOMP (Specialized Training of Military Parents) provides information and resources to military families, individuals with disabilities, and both military and civilian professionals serving military families enrolled in EFMP. Register for upcoming STOMP workshops and webinars to learn more about the lifespan of benefits available to military families under federal law and military programs.

Military OneSource is an official DoD website and a information hub for all aspects of military life. EFMP & Me, a companion website managed by Military OneSource, organizes hands-on tools, federal and state information, military and civilian services and resources, and related supports and programs in one place.

Additional Resources

Legal Resources for Highly Mobile Military Families

Military families have unique circumstances that can call for out-of-state or specialized assistance.  For example, when they move to a new duty station, they may need to find a lawyer in the state to which they are moving to help them establish a new guardianship for an adult child with disabilities. Fortunately there is an online resource from the American Bar Association: ABA Home Front, created to help military families get legal assistance both on and off the installation.

ABA Home Front helps users locate and contact free, low-cost, and standard fee-for-service lawyers by state. Each listing shows the type of law practiced.  Example: “Landlord-Tenant Law, Family Law, Wills”.  There’s a search engine to find a fee-for-services lawyer by legal topic.  Many states also include contact information for the Judge Advocate General (JAG) offices at that State’s military installations.

Some States have more robust listings than others. California, for example, which has large military-connected populations, has several county and city legal programs with a focus on specific military issues, including veteran’s issues. However, every State page gives a family the opportunity to search for a program or a lawyer that will work for their situation.

Families (both military and civilian) can visit another ABA page to find a State Bar Association, and use a search function to locate a lawyer for a specific purpose.  If, for example, an active-duty family wanted to plan support for an adult child with a disability, they could use terms like “military”, “disability”, “estate planning”, and “guardianship”.

If a family has no internet access, most telephone directories will have a phone listing for a local or State Bar Association that can give information on which lawyers specialize in their area of need.

Families still have to check out the program or lawyers they locate, and select the lawyer based on their own needs, financial situation and whether they believe a lawyer is right for them. ABA Home Front has a section called “Working with a Lawyer” which is a great place to start. The page gives answers to essential questions like:

  • What exactly is a lawyer?
  • What are the professional requirements to become a lawyer?
  • What about lawyers who work with military families? Do they need to have any special training?
  • Are there specific cases when I should see a lawyer?
  • Should I save money and wait until I absolutely need a lawyer’s services?

When a family is ready to look for a lawyer, your Parent Center may be able to refer them to a specific practice. Sometimes, when the search needs to go out-of-state (a lawyer that does Special Needs Trusts, for example) you may need a few more suggestions for organizations or search tools that can help:

Other National Legal Resources

The ARC of the United States is an organization for people with intellectual and developmental disabilities which has state and sometimes county- level chapters.  They are known for referring families to lawyers with appropriate experience in the disability legal field. The national website has the online Center for Future Planning which encourages families to search for professionals such as lawyers and financial planners.

Disability issues: the Council of Parent Attorneys and Advocates (COPAA) has a web page to search for member attorneys. The site also gives guidelines for choosing a lawyer or advocate.

Disability Rights Education and Defense Fund (DREDF): civil rights legal action and public policy organization which operates one of California’s Parent Centers. For families interested in the legislative or civil rights aspects of their legal concerns, or who need Parent Center services in Alameda, Contra Costa, or San Joaquin counties.

Family Network on Disabilities (FND) is a national network organization which operates three Parent Training and Information Centers in Florida. They also offer a Special Needs Trust Administration which provides comprehensive trustee services nationally. They don’t prepare trust documents but are available to review any documents prepared by a family’s attorney (fees apply).

The Military Families Learning Network connects military family service providers and Cooperative Extension professionals on topics focused on the needs of military families.  Many of the webinars are also suitable for families.  A good basic look at future planning is in their webinar, Estate Planning for Families ith Special Needs on YouTube.

Wrightslaw Special Education Law and Advocacy offers the Yellow Pages for Kids website, a search tool to find “educational consultants, psychologists, diagnosticians, health care specialists, academic tutors, speech language therapists, advocates, and attorneys.”