The Defense Health Agency’s TRICARE "school-exclusion" policy is forcing military families to choose between in-school ABA therapy and public education, driving experienced operators to consider early separation. South Carolina’s Act 186 (May 2026) guarantees in-school ABA, but TRICARE’s Autism Care Demonstration stops reimbursement when therapy occurs on school property. A Summer 2026 survey found 100% of affected mid-career operators plan to leave service and 80% of families shifted dependents to Medicaid waivers, costing taxpayers about $6,383 per child annually. Advocates and NASEM urge Congress to end the ACD demonstration and make ABA a TRICARE Basic benefit in the FY2027 NDAA.
Broken Defense Healthcare Rule Is Driving Elite Warfighters Out Of Service
Kayleigh Norton, Applied Behavior Analysis therapist, reviews animals and colors with a six-year-old military child diagnosed with Autism Spectrum Disorder. (Senior Airman Dennis Sloan/U.S. Air Force)
When the military confronts a retention crisis among high-value, highly trained personnel — from Explosive Ordnance Disposal (EOD) technicians to aviation specialists — observers typically point to operational tempo, private-sector pay or deployment strain. An avoidable administrative policy is now a major and underreported driver: a TRICARE rule that effectively penalizes service members whose children require in-school behavioral health services.
The Law, The Policy Clash, And Who It Harms
In May 2026, South Carolina enacted Act 186 with broad bipartisan support. Framed under the Americans with Disabilities Act, the law guarantees that autistic children may receive medically necessary Applied Behavior Analysis (ABA) therapy inside public school classrooms so they do not have to choose between education and care.
But active-duty families stationed at Joint Base Charleston and elsewhere in the state report being denied those protections. The Defense Health Agency (DHA), through TRICARE’s Autism Care Demonstration (ACD), continues to apply a strict "school-exclusion" policy: TRICARE halts provider reimbursement the moment a behavior technician sets foot on public school property. Civilian families with commercial insurance can rely on state-law safeguards; military families are given an impossible choice—remove a child from public school to keep therapy in a clinic, or forgo medically necessary care so the child can remain in school.
Operational And Fiscal Costs
The consequences are both tactical and fiscal. Summer 2026 field survey data from The Military Family Advocacy Group found that 100% of surveyed mid-career, active-duty operators affected by TRICARE autism denials are planning early separation from service. When specialized operators—EOD technicians, pilots and others—are consumed by an exhausting administrative fight at home to secure routine care for a child, unit focus and mission readiness suffer. The services invest millions and years developing these warfighters; losing them over an administrative setting restriction is a self-inflicted readiness loss.
There is also a local taxpayer burden. Because TRICARE denies in-school coverage, 80% of surveyed military families have enrolled dependents in state-funded Medicaid waivers to obtain necessary services. That substitution imposes an estimated $6,383 in net annual tax cost per child on South Carolina taxpayers for care a federal defense program should be providing.
What Experts Recommend—and What’s Been Ignored
In 2025, the National Academies of Sciences, Engineering, and Medicine (NASEM) issued a comprehensive report recommending that DHA end the 12-year ACD demonstration status, designate ABA as a standard TRICARE Basic benefit, remove arbitrary setting exclusions, and eliminate burdensome assessment mandates. Despite these independent, science-based recommendations, DHA has not implemented them.
Call To Action
Because administrative fixes have not been forthcoming, Congress should act. As lawmakers finalize the fiscal 2027 National Defense Authorization Act, they should include statutory language requiring the secretary of defense to terminate the ACD demonstration, align TRICARE benefits with NASEM recommendations, and prohibit DHA from denying medically necessary care based on educational or geographic setting.
South Carolina has moved to protect children under state law. It is time for federal policymakers to ensure military families receive the same protections, remove the school-exclusion barrier, and safeguard the readiness of the total force.
Mariah Wilkins is the executive director and principal policy advisor of The Military Family Advocacy Group.
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