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October 10, 2018
Defense Health Primer: TRICARE Extended Care Health
Option (ECHO)
Since the 1950s, Congress has been creating various
programs to support military quality of life, including
TRICARE, Transition Assistance Program, Department of
Defense (DOD) schools, child care centers, and Morale,
Welfare, and Recreation programs. Military families who
have special needs also encounter additional challenges
with accessing and maintaining consistent health care, child
care, and education across frequent moves. To address
those issues, Congress created the TRICARE Extended
Care Health Option (ECHO) in 2001. The purpose of
ECHO is to provide supplemental services for military
families with special needs, similar to home and
community-based services offered by state Medicaid
programs (e.g., rehabilitative services, durable equipment,
assistive technology devices, institutional care, home
health, autism therapies).
From 1967-2004, DOD administered the Program for
Persons with Disabilities (PFPWD), which offered health
services for military family members with special needs.
The purpose of PFPWD was to provide additional non-
medical services, not generally covered by TRICARE, to
military families who face unique challenges in accessing
special needs services due to the nature of military service.
Services provided to beneficiaries through PFPWD were
statutorily capped at $2,500 per month. Prior to 1997,
PFPWD was known as the Program for the Handicapped
As part of a broad effort to reform sub-acute care benefits
(e.g., skilled nursing care, case management, long-term
care, and disability support services), section 701 of the
National Defense Authorization Act for FY2002 (NDAA;
P.L. 107-107) replaced this program by directing DOD to
provide extended benefits to assist military family
members with the reduction of disabling effects caused
by a physical or mental disability/condition. In 2004, DOD
issued a final rule (i.e., 69 Federal Register 44942-44952)
to replace PFPWD with ECHO, broadening the services
available to allow service members to focus on their
mission-related responsibilities. Since then, Congress and
DOD further expanded the types and amounts of available
services (e.g., increasing the annual benefit cap to $36,000
[P.L. 110-417 §721], adding respite care hours, and
covering certain therapies for autism spectrum disorder).
Dependents of active duty service members are the only
category of DOD beneficiaries eligible for ECHO. Neither
reservists and their dependents nor retirees and their
dependents are eligible. To participate in ECHO, the
dependent must be enrolled in a TRICARE health plan
(e.g., Prime, Select, or the Uniformed Services Family
Health Plan), enrolled in their service's Exceptional Family
Member Program, and have a qualifying physical or mental
disability/condition. Eligible dependents register for ECHO
through their respective TRICARE contractor's case
management program.
Qualifying Physical or Mental Disabilities/Conditions
* Autism Spectrum Disorder
* Moderate or severe intellectual disability
* Serious physical disability
* Extraordinary physical or psychological condition that
results in a beneficiary being homebound
Neuromuscular development condition or other
condition in an infant or toddler that is expected to
precede a diagosis of moderate or severe intellectual
disability or a serious physical disability
* Multiple disabilities, which may qualify if there are two or
more disabilities affecting separate body systems
In FY2017, there were 18,898 beneficiaries registered for
the ECHO program, which was a 34% increase in
registrants since FY2013. Army beneficiaries represent the
largest group of ECHO participants. Additionally, autism
spectrum disorder is the most common diagnosis, impacting
approximately 78% of ECHO participants.
Figure I. Beneficiaries Registered in ECHO, FY2013-
FY2017
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Source: Department of Defense, 2018.
Notes: Due to their low counts, beneficiaries of the Public Health
Service (PHS) and National Oceanic and Atmospheric Administration
(NOAA) registered in ECHO are omitted from this graphic. In
FY2017, PHS had 95 beneficiaries and NOAA had 4 beneficiaries
registered in ECHO.
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