The mental burden of using military benefits

Jennifer Barnhill is a columnist for Military.com who writes about military families.

When I first moved to my husband’s current duty station, a woman on the other end of the line at Tricare West’s call center said the local military treatment facility (MTF) was full. and was no longer taking new patients. They gave me the name and phone number of a local doctor and sent me on my way.

After weeks of leaving unanswered messages, I finally found someone at the doctor’s office.

“I’m sorry, I know our website says we’re accepting patients, but that’s old information,” the receptionist said.

I called Tricare and was assigned a new doctor, only to be turned away again because the office was not accepting new Tricare patients. It happened a total of three times.

When I finally called Tricare West after being turned away by the third doctor, it had been so long that a spot had opened up at the MTF. When I expressed my frustration at this mess, I was told I needed to call another number to help update the Tricare provider list. This was the mental burden handed to me because my husband had orders from the Navy to move to a new office location.

I was lucky. All three of my children were assigned to doctors right away, and no one in my family is medically complex. For those who must line up specialty care or mental health, the back and forth can become a full-time job. But is the mental burden of using military benefits to be expected or an indicator of a broken system?

“My son was enrolled in the CDC [military base child care]but because of his behavioral issues and sensory issues, he was being kicked out almost daily,” said active duty Airman Master Sergeant Rachel Kegley. When she shared her concerns with her pediatrician, she was told that the her son would come out of it.When she brought him in for his kindergarten physical three years later, the provider sent a referral for a neuropsychological evaluation so he could give the family answers.

“We called all over town; nobody had openings,” Kegley said. When she finally got an autism diagnosis for her son, Kegley turned to the Exceptional Family Member Program (EFMP) for resources and support. But after an initial phone call, she says she didn’t hear back from the care coordinator. So he kept making calls. “Most of them don’t take patients or they don’t take Tricare anymore. It’s the same with pharmacies. You call to try to find a drug for your kids, and they don’t have the drug or they don’t take Tricare. It’s very challenging.”

The concept of “mental load” or invisible work has gone viral in recent years, largely focusing on small but annoying tasks that often go unrecognized at home and work and pile up disproportionately to women: make doctor’s appointments, check up on the kids. ‘ backpacks to make sure there aren’t any crumpled permit documents hidden under a rotten banana, etc.

It means living with a never-ending to-do list. It’s the small tasks that keep a family going, but can wear down the person carrying most of the “load.” When the already complex process of accessing benefits is combined with military bureaucracy, the mental burden can be great.

“There are so many hoops to jump through and we spend a lot of time applying for these things,” said Amanda Larimore, Air Force spouse and parent of a child diagnosed with autism spectrum disorder.

Despite being eligible for support services, Larimore reports having difficulty accessing services such as respite care, a program that allows families to receive up to 20 hours a month of specialized care for physical and neurological disabilities . However, accessing this benefit can be difficult. Larimore reports that leadership has been working to strengthen the network, but until then, the only available providers are in a different state, hours away.

Larimore was told there was a shortage of providers, but found there actually were providers, just none participating in the respite care program.

Families in the Exceptional Family Member program, like the Larimores, may experience a more obvious mental burden. They have to fill out more paperwork (military and civilian) and are often under the care of more than one doctor, requiring referrals and more likely to be on waiting lists. Families expect to be assigned a base in an area that can meet their needs, but this is not always the case.

“Families said they have been to some EFMP approved locations, but because there are so many EFMP families there, there are no services because all the services are already taken,” said Dr. Jennifer Kremkow , associate professor at Elmhurst. University Kremkow has published numerous studies examining the experiences of military families whose children have autism.

“Something that a lot of the parents discussed was just the challenge of managing everything, especially if their service member was otherwise busy, if they were separated or on training,” she said.

According to the Tricare for Kids Coalition (TFK), an organization that advocates for access to health care for military children, the Air Force has sent many EFMP families to Colorado Springs, Colorado, as a designated EFMP location. However, in October 2023, the Defense Health Agency reduced Tricare reimbursements by 40% for some outpatient services. Children’s Hospital Colorado in Colorado Springs later filed a lawsuit against the Department of Defense over this change. While EFMP families in the area have yet to report an outage, according to TFK founder Kara Tollett Oakley, the coalition is concerned about disruptions in access to care when demand is high and low reimbursement make it difficult for providers to serve military families.

But it’s not just EFMP families who experience the mental burden.

“The military grant has been nothing but a challenge and a headache,” said Jennifer O’Donnell, owner and operator of Uptown Children’s Academy who is also married to a retired Marine. Both the Military Child Care in Your Neighborhood and Child Care in Your Home programs provide fee-based assistance to military families who cannot access military-operated, but separately managed, child care. “They’ve had some parents give up because after six or seven months of sending the same things over and over and over again, they just get to a point where they’re done.”

Aria Spears, a military spouse who was struggling to find daycare so she could keep her job, knows this battle firsthand. “We were working to find a baby [child care] for nine months and I haven’t found anything, but finally today, after I don’t even know how many calls, how many times we’ve called the same place over and over and over the past few months, someone called me with this place, “Va said Spears. “But I quit my job two weeks ago because I thought it was impossible to find childcare.”

Finding affordable health and child care is a struggle for all Americans. However, studies show that military families report having a harder time because of how often they need to re-establish care. “Now we’re finding that because these things exist in the civilian sector, like shortages and specialists, waiting times and frustration with how the system works, that’s being used to excuse the many barriers that exist for military families”. Tollett Oakley said.

“The problem is an erosion of profit that’s happening behind the scenes,” said Karen Ruedisueli, director of health affairs and government relations for the Military Officers Association of America. “If you want to manage health care costs in Tricare, you can cut the networks, you can cut the coverage policy, you can raise the rates on people. The rate increases are very obvious to everybody.”

If child care providers like O’Donnell or organizations like Children’s Hospital Colorado feel the juice isn’t worth the squeeze, they can choose not to sign up as military family providers. Since there are no cuts, there is no clamor to protect the profit.

Families feel the mental burden of a lack of providers and are reminded to “hug the pacifier.”

When delays, waits, and hold times are expected and not tracked, they can easily be dismissed as anecdotes. But if this “mental load” were tracked, it could prove to be a useful indicator of health and the actual affordability of military benefits.

— In addition to her reporting, Jennifer Barnhill also hosts Conversations at the military dinner table, a monthly upside-down town hall with military families. She is a 2023 Bush Institute StandTo Veteran Leadership Program studentthe editor-in-chief of the National Network of Military Joints‘s Career Connections Magazine and the Military Spouse Link Memorial Project of the League of Wives.

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