Ten-year-old Logan Cabiao is nonverbal and depends on hands-on therapy to learn everyday skills. His mother says TRICARE's rules have turned simple routines, brushing teeth, handwashing and getting dressed, into months-long paperwork fights and appeals. Their experience is one of several military-family stories that highlight a growing gap between what many civilian insurance plans cover and how the military organizes autism care.
TRICARE keeps ABA inside a demonstration program
Unlike most commercial plans, the Department of Defense reimburses applied behavior analysis only through the Comprehensive Autism Care Demonstration, rather than as a routine TRICARE Basic benefit. The demonstration assigns an Autism Services Navigator, requires preauthorization of individualized treatment plans and periodic standardized assessments, and excludes many school-based "shadow" supports, changes implemented in 2021 that families and providers say piled on administrative burden. As outlined by TRICARE, those steps must be completed before many ABA services will be authorized.
National Academies: the evidence meets the threshold
A 2025 consensus review by the National Academies concluded that the scientific evidence supports ABA and that the therapy meets the Defense Department’s criteria for reliable medical effectiveness. The committee recommended that the Defense Health Agency discontinue the demonstration and authorize ABA as a Basic TRICARE benefit, and it warned that the demonstration’s mandatory, uniform assessment collection has imposed unnecessary burdens on families and clinicians. Those findings and recommendations are documented in the National Academies report.
Families say paperwork and denials have real costs
Parents interviewed by NBC News say TRICARE’s rules have narrowed access to hands-on ABA sessions that teach life skills and that billing errors, delayed reimbursements and denied claims are common. The Cabiao family of Niceville, Florida, and Kristi Cabiao’s advocacy group Mission Alpha, founded in 2021, are among those pushing for policy change.
Pentagon: statutory and programmatic hurdles remain
In responses recorded in the National Academies review, the Defense Health Agency told the committee that authorizing ABA as a TRICARE Basic benefit would require a formal determination that the therapy meets statutory evidence thresholds, notice-and-comment rulemaking, and decisions about authorized providers and reimbursement rates. The academy framed those barriers as policy steps that could be taken but cautioned that current requirements have strained families and providers. See the Defense Health Agency responses and the committee's recommendations in the National Academies report.
What comes next for military families
The committee urged DHA to stop the mandated use of a specific battery of assessment tools, identify authorized ABA providers and rates, and fold ABA into TRICARE’s Basic benefit so care looks more like civilian coverage. Whether the Pentagon follows those recommendations or Congress alters the law is the next big question, and advocates note that most states already require commercial insurers to cover ABA, according to the National Conference of State Legislatures. TRICARE continues to operate the demonstration under its current authority while families and advocacy groups press for changes aligned with the academy’s findings.
