Military bases have been making news over the last several years, but not for military maneuvers or deployments. Instead, many bases around the world have been feeling the direct impacts of climate change in the form of powerful storms and weather systems.

Now a group of former top military leaders and national security experts have created a sweeping plan of action to protect our nation from “these unprecedented security risks urgently and comprehensively.”

Military Bases Brace for Impact of Climate Change

The Climate Security Plan for America was issued by the Center for Climate a Security, a DC-based think tank, along with the Elliott School of International Affairs at George Washington University.

“The Climate Security Plan for America is a call for Presidential leadership to prioritize this challenge and take action to protect our national security in the face of the coming storm,” said John Conger, director of the Center for Climate and Security.

The plan has been endorsed by 64 leaders in the US military and national security, including Gen. Larry Welch (R), former chief of staff of the U.S. Air Force; Adm. Samuel Locklear (R), former commander of U.S. Pacific Command; and Gen. Anthony Zinni (R), former commander of U.S. Central Command.

Majority of Bases at Major Risk Due to Climate Change

This proposal, while limited to managing future risks rather than slowing or reserving climate change immediately, follows closely on the heels of a major Pentagon report discussing the projected impact of severe weather related to our changing climate.

Released in June 2018, the DoD-commissioned report found that about half of all US military bases, CONUS and OCONUS, are at risk for flooding due to climate change-related severe weather. Other risks reported at over 50% of military bases due to climate change included wildfires, storm surge, high winds and drought.

Many bases are already feeling the impacts of increased severe weather patterns. MCB Camp Lejeune, AFB Tyndall, MCAS Cherry Point and AFB Offutt have experienced devastating weather patterns, including hurricanes, between August 2018 and August 2019. Tyndall is still trying to recover after being virtually destroyed. In addition, Okinawa, a major hub for US military forces of all branches in the Pacific, has been experiencing multiple major typhoon systems during the 2019 season.

Weather-Related Destruction Impacts Military Missions

While military families feel the impact of severe weather on the homefront, it also complicates the national security and defense missions the troops are tasked with carrying out daily.

As of late May, the Air Force was still struggling to repair the massive damages at AFB Tyndall. Virtually every single structure was damaged or completely destroyed as a result of Hurrican Michael in 2018.

One year later, the Air Force was still waiting for Congress to pass an aid bill that would allow this base to rebuild.

MCB Camp Lejeune was also waiting for funding from this same $19 billion bill in order to continue repairing damages from Hurricane Florence in September 2018. Estimates in December 2018 put the cost to rebuild and repair at $3.6 billion.

Without this funding, the Air Force, as of May 2019, was looking at cutting thousands of hours of training flights. With multiple Air Force bases severely damaged by storms over the last year, the budget has been stretched thin in order to cover the massive cost to repair the destruction.

At Lejeune, military families have already seen how Hurricane Florence has hit their Marines’ missions. As of November 2018, incoming families were told to look for housing off-base due to hurricane damage.

Addressing the Present Climate Change Danger

The proposal from the Center for Climate and Security focuses on risk management for climate-related impacts on the military mission. However, it does not propose strategies or solutions that will stop or reverse climate change.

Some bases have taken steps on their own to address energy and resource in a way that minimizes the impact on the environment. Fort Hood currently receives 40% of its energy from renewable sources, including solar and wind power. Eventually, base leadership would like to create a microgrid that can sustain the base in the event the larger power systems fail.

“(M)ilitary planners don’t have the luxury of playing politics on the issue. They know that they have to do what’s required to ensure our country is kept secure and safe,” Maj. Gen. Rick Devereaux (R), former director of operational planning, policy and strategy for the U.S. Air Force, explained to Yale Climate Connections.

Has your duty station felt the impact of climate change-related weather? Share your experiences in the comments.

We all know that just getting in to see the doctor can be a hassle. But when you’re trying to navigate the healthcare system with a child who has medical complications, it can be downright scary.

Tricare Issues for Military Kids

All kids might face issues and concerns with the Tricare system though. And you deserve to know what you’re facing.

Referrals to Specialists

Need to see a (fill in the medical specialist here)? Oh, that’ll be a 6-12 month wait! That’s if they’re in-network and accepting new clients.

Sure, sometimes you get lucky and can get in ASAP, but often there’s at least some waiting involved.

On Tricare Prime and USFHP, beneficiaries are required to get a referral from their PCM in order to see a specialist. While Prime and USFHP offer no or very low-cost co-pays for all services and referrals, finding and getting into a provider can be difficult.

Select beneficiaries can select their own in-network specialists without a referral, but getting in to the correct person can still mean they’ll be waiting.

Often, on-base specialty clinics are full or limited to active duty personnel. Other times, finding a specialist who is in-network, accepting new patients and within a reasonable driving distance is a struggle.

Help! I Need Advice!

Perfect! That’s what the Nurse Advice Line is designed for! You can call 1-800-TRICARE (874-2273)—Option 1 to speak to a registered nurse about your concern.

The nurse you speak to can listen to your child’s symptoms and the progression of the illness/injury. Then, they’ll provide the next best steps in terms of seeking treatment or providing care at home. The nurses can even help you locate an ER or urgent care clinic.

Where Do I Go If…?

For military families, knowing where to get medical care in the event of an urgent or emergent medical issue is vital. Emergencies never seem to happen when you’re safely tucked into your familiar hometown. No, your child is sure to get into something dangerous or spike a terrible fever when you’re somewhere completely new. Of course.

What do you do then?

First, you no longer need pre-authorization to seek treatment at an urgent care center near you. However, there’s a catch: your urgent care center must be in-network. In some cases, that could mean driving long distances to be seen somewhere in-network even though there is a perfectly good clinic within 5 minutes.

After you’re seen, just call Tricare’s regional call center to let them know about your visit. If you’ve gone out of network, be prepared to pay point-of-service co-pays.

Second, you can be seen at any ER anywhere. If you’re on Prime, be sure to call Tricare to let them know about your visit or if you’ve been admitted.

Getting the Records Straight

Moving every three years doesn’t make it easy to keep records, even digital ones. Ensuring that your child’s medical files are complete and accurate can be a full-time job, especially when they run to the hundreds of pages – as is the case for many medically complicated children.

With each move and every new report generated, there is more to keep track of and pass along between providers.

Making sure that the most important details, like a deadly allergy or surgical records, be communicated is extremely important.

If you’re working with off-base, civilian offices, getting the records for your records can be costly. Many medical offices charge a fee per page copied but will transfer your records digitally or via fax to another doctor’s office for free.

Getting Coverage

Can you see that provider or get that needed supply now? That’s a strong maybe!

Not all medical care needs fit into neat little boxes. What is needed for one child to thrive may be excluded under current Tricare policy.

For example, dyslexia treatment is not allowed, but ABA therapy is covered as long as your child is enrolled in a special Tricare program.

Figuring out which much-needed providers will be covered by insurance or should be added to your already tight budget can be an extreme balancing act!

Do We Need ECHO?

The Extended Care Health Option (ECHO) is available to support military families with medical needs that might go beyond standard Tricare coverage. These can include home nursing and some supplies, like diapers.

ECHO offers a lifeline for many military families, at a low cost-share, who are struggling to meet the needs of a medically complicated child while also being financially smart.

Hospice Care Now Covered

No one wants to consider this scenario, but it’s comforting to know that hospice care is now an option for military dependents and troops. Hospice is designed for people who have a life expectancy of fewer than 6 months. Care will focus on comfort and daily living rather than a treatment plan in hopes of a cure.

However, military families have to choose between hospice and treatment. You cannot have both services operating concurrently.

What are your experiences navigating Tricare with your child – medically complex or typically developing? We’d love to hear your stories!

New parents connected to the military have relied on Tricare’s breastfeeding support programs for years. Moms have received breast pumps and supplies for free. Now, parents of some infants may also qualify for donor breast milk, too!

Expanding safe feeding options that allow parents a variety of solutions that fit the business of military life is always a good thing. But all this good also comes with a few hiccups.

New Moms Face Snags with Tricare Breastfeeding Changes

While donor milk coverage has been added, the notoriously generous breast pump program has been slapped with new restrictions.

$16 Million Breast Pump Overspend Leads to Major Changes

During a 2018 Inspector General audit, over $16 million in overspending on breast pumps and associated supplies was discovered. In one case, a breast pump that normally cost $200 at major retailers was billed at $1400 to Tricare.

These inflated bills were caused by beneficiaries purchasing a pump directly from a medical supply company, which would then bill Tricare. Another option was to purchase a pump from other retailers on their own, submitting their receipt for reimbursement later.

Now, Tricare is instituting a reimbursement cap and streamlining the process for filing a claim.

Here’s what you need to know now:

• Tricare will reimburse qualified beneficiaries up to $312.84 (CONUS) or $500.55 (OCONUS) during 2019
• There are no restrictions on where beneficiaries may purchase their pump
• Deluxe models are no longer allowed; contact your Tricare call center for specifics
• To get reimbursed for a pump, you must have or obtain a prescription from your PCM or another in-network provider
• Initiate your claim for DD-2642; attach your prescription and a copy of your receipt when submitting the claim
• There are limits on milk collections containers, replacement parts and other associated supplies
• You are limited to one pump per birth event

For questions regarding the specifics of your coverage, please contact your Tricare regional office. You can call Tricare East at 1-800-444-5445 or Tricare West at 1-844-866-9378. Members stationed OCONUS should also call their regional call center.

Canceled Orders, Big Debts

With the major changes to how Tricare handles breast pumps, many beneficiaries have been left up in the air.

As of July, over 5,000 claims were pending at Pumping Essentials. The CA-based company also canceled all current and future orders of pumps and supplies for Tricare beneficiaries.

Pumping Essentials has also officially cut ties, for the time being, with the Pentagon due to outstanding debts owed on already ordered pumps and supplies. In July, the DoD owed Pumping Essentials over $1 million for past orders and claims. Pumping Essentials, in a prepared statement, claims that contractors like Humana and HealthNet were negligent in paying bills on time.

“[The contractors] have drastically mismanaged the handling of these claims, resulting in significant amounts of unpaid claims to Pumping Essentials and many other providers. … At this time, the volume of unpaid claims has put our company in a position where we can no longer sustain the debt that is accruing,” wrote Pumping Essentials officials.

New Benefit, Zero Instructions

Parents of infants with certain medical concerns can now access milk banks with limited or zero cost. But the implementation of this new benefit has been anything but smooth.

Donated milk is used to help totally feed or provide a supplemental food source for infants who meet one or more medically complicating conditions:

• very low birth weight, often due to extreme premature birth
• disorder or surgery that impacts the GI tract
• failure-to-thrive diagnosis
• unable to drink formula, causing weight loss or failure to thrive
• low blood sugar
• heart disease
• organ transplant
• when maternal milk isn’t available and the infant has a serious health concern
• other serious health conditions, at the discretion of the PCM or specialists

Milk banks are located around the country and world, but the extremely high cost has limited or prevented access for many. Donated milk can cost as much as $5 per ounce, with daily bills costing upwards of $150 during peak consumption periods.

Military families have gone deeply into debt trying to care for their new baby. With Tricare’s new policy, retroactive to January 2019, military families will bear less of a financial burden in an already stressful situation.

However, Tricare and the Defense Health Agency announced this new policy without creating or communicating a complete plan of action to providers and associated agencies.

There are questions about what is covered and who is responsible for different elements of using donor milk.

Lactation specialist Pauline Sakamoto said that Mothers’ Milk Bank in San Jose, CA was overwhelmed with calls after the new policy was introduced.

“There continue to be questions as to what the benefit is and what the families are responsible for paying,” Sakamoto said. “For example, shipping costs. Is that part of Tricare coverage or not? And to some extent, Tricare has a co-pay, but we aren’t seeing that families are getting requests. There are a lot of issues right now swarming around this coverage.”

Getting Your Baby Banked Milk

Right now, parents who are interested in exploring how donor milk may benefit their baby should speak to their PCM or medical care team. A prescription is required.

Your child’s doctor should be actively monitoring your baby’s case and writing a new prescription every 30 days. Babies may consume donated breast milk, covered with a prescription, until 12 months of age as long as it is deemed medically necessary.

Parents may need to pay for the donor milk upfront, submitting a claim to Tricare for reimbursement after the fact. With all claims, parents should submit an active prescription and their bill from the milk bank.

In case of confusion, call your Tricare regional call center stateside or overseas. Customer service representatives should be able to help you navigate the billing and reimbursement loopholes.

Have you used either the new breast pump or donor milk benefit? We’d love to hear about your experiences!

EFMP or the Exceptional Family Member Program. It’s supposed to be a program to help military dependents access care, find advocates and only PCS to locations that can really, truly serve their needs.

Except it doesn’t always work that way.

Military spouses hear from commands and MTFs that EFMP will totally help them! It’ll be so much easier to ensure access to the right health care providers, additional support services and education programs (for kids) at wherever they’re stationed.

They hear that it’s “mandatory” to be enrolled.

And then they hear the horror stories from other families, detailing all the things that have gone wrong, promises left unfulfilled and careers derailed.

So what’s the truth about military spouses and EFMP? We went straight to the source – military spouses with EFMP experience that run the gamut.

Digging into Real EFMP Stories from MilSpouses Who’ve Been There

Enrolling in EFMP is supposed to be simple, just some paperwork. Paperwork that you should be able to grab right at your on-base PCM. And your PCM should be helping to determine if you or your children are eligible to begin with.

That’s not always the case, as some military spouses have discovered. Air Force Spouse, Susan R., was given some faulty information

“I should have been enrolled years before, but was told some inaccurate information about EFMP and the population the program serves,” she said. “I was informed by my PCM in 2008, that EFMP was a pediatric program and that adult specialty medical care could always be found. Sadly, that’s not entirely accurate.”

Adults are, in fact, eligible for enrollment in EFMP. But this might not always be clear to your PCM, military or civilian.

Other spouses, like USMC spouse Melissa, were surprised with their EFMP status.

“I had a temporary condition that I did not know qualified me for EFMP, and I was enrolled in EFMP without anyone contacting me or contacting my active-duty spouse,” she explained. “I believe I was enrolled for about two years. When it came time to PCS, we suddenly found out that I was in EFMP, since it came up on the checklists. That was a surprise!”

Unlike Melissa, Susan found enrollment challenging, contrary to the “easy process” touted by the military powers that be.

“Enrolling in EFMP seems to be an easy process, too,” Susan shared. “Fill out a form, get the PCM to fill it out, sign it and that’s it. Sadly, that’s not it. Depending on the diagnosis there could be many physicians and specialists involved needing to fill out and sign paperwork. That process can be long and drawn out.”

Once in “the system,” many military spouses felt let down by the support and services they experienced.

Melissa felt completely ignored by the whole process. Not only was she not informed of her enrollment, she was barely involved in the process to get out.

“I saw a distinct lack of communication from the EFMP service at the base where we were, Melissa said. “I could not believe I’d been signed up and no one from the office contacted me. (It) took him three tries to get to someone who knew what forms we needed to get me out of the program. Then, the final in-person interview we needed to attend was only scheduled through my spouse, not me. He called and asked if I could attend the meeting time. No one from EFMP reached out to me then, either.”

Even though getting into EFMP, and apparently getting out as well, might be a challenge, there are some positives to this program.

“The base we were at had good programs for EFMP members, in terms of regular gatherings and events for both kids and adults,” Melissa said. “I think it was a good program for those who knew they were in it.”

Susan, an Army kid turned Air Force spouse, remembers the days pre-EFMP. In her eyes, the positives come close to balancing out the negatives.

“The positives of EFMP means that families with medical needs are being considered when the service member is up for an assignment,” she said. “I was an Army kid and I remember life as EFMP was being rolled out by the Army. We had families getting stationed in places where their medical, educational and family support needs were never considered. The stress on families was overwhelming. In some cases, rare cases, family members would get very sick and not have the medical care they needed.”

Good & Bad of EFMP

USMC Spouse Jen C. has seen both sides of EFMP. Both Jen and her children are enrolled in EFMP.

“I have been enrolled as EFMP member since 2003. I also am a disabled vet and have physical limitations,” Jen explained. “I had my oldest May 2005. I was given respite. I used respite with the CDC on base. I was given I believe 16 or 20 hours of respite a month. It actually helped our family since my husband was an e-5 and I only had a 10% service connected disability rating at the time.”

Respite care, available to EFMP-enrolled adults to care for their children as well as for EFMP-enrolled children, provides a qualified sitter or care providers. Families then apply for reimbursement at a set rate and for a particular number of hours.

However, after 2009, Jen saw EFMP change – and not for the better in her estimation.

“After 2009 things changed drastically because of the sequestration,” she said. “EFMP respite was than non-existent for EFMP adults.”

Will It Impact the Military Career?

Career issues top the list of why military families try to stay off of EFMP rosters. But if you’re talking to military powers that be, negative career effects are basically non-existent. But what’s the truth?

Actually, it seems like it’s both.

EFMP basically ensures that military families are not moved to locations without the correct services and supports. At least, it’s supposed to prevent that.

In reality, EFMP status can limit duty station options and lead to unaccompanied tours.

Army spouse Megan H. has experienced two unaccompanied tours and denial of tours, all due to EFMP-enrolled dependents. There are multiple EFMP-qualifying individuals in her household.

“(W)e were not just denied accompanied overseas assignments, but CONUS assignments as well,” Megan shared in her personal story. “(The) doctors, without understanding the process, not only ended up putting a wish list of services on each of my daughters’ forms (for now my three oldest all qualified to be enrolled) but they also enrolled me for about six or seven different diagnoses, some of which I didn’t really have, as well as listing approximately seven or eight providers that I needed to see either weekly or monthly for those diagnoses.”

Susan also saw impacts to her spouse’s career. While the personal impact is negative, she can also see the rationale behind the policy.

“(W)e were unable to move to a location that would have helped his career progression. The lack of medical care meant that my family was denied travel to that location. We ended up staying at a location for close to 8 years,” she explained. “I also believe that EFMP is supposed to impact the service member’s career. I’m sure this seems strange, but this is what I believe. If DoD didn’t have EFMP, then families who have children with autism, are diagnosed with cancer, have illnesses that require specialty medical care would move to duty stations and never be able to access the care and services needed.”

A new USMC study appears to show that there is little to no longterm impact on Marine’s careers.

“Not only did we find that career advancement was not distinguishably impacted by EFMP enrollment, we also learned that, on average, EFMP enrollees serve slightly longer than their non-EFMP active duty counterparts, achieve a slightly higher grade, and the majority achieve that high grade in the same or shorter amount of time than the average of their non-enrolled peers,”  said Jennifer Stewart, the EFMP Section Head for Marine and Family Programs.

What Happens If I Don’t Enroll?

If your EFMP-qualifying issue is mild or well-controlled, then this should be listed on your medical paperwork. Opting to avoid enrolling is a 100% personal decision that needs to be based on multiple factors.

However, before choosing to skip EFMP, it’s important to understand the implications.

• Moving to a duty station where limited or no services are provided via MTFs or in-network civilian medical providers
• Being located in a place with limited or no support services, like ABA therapy
• Moving to a location where routine, infrequent maintenance screenings or check-ups are unavailable

Basically, you could be in a place where the things you or your child needs to cope with your diagnosis are just not available. While some diagnoses or individuals might be able to manage, others may not. And you just won’t know what’s there until you get there.

Susan appreciates the fact that her family’s duty station options are more limited.

“My husband and I are good with not being able to move to a location that doesn’t have the medical care to support our family,” she shared. “Our family is the most important thing which means having access to medical care that we need.”

However, Jen found that the system failed her family,

“We had serious waitlist issues in FL,” she explained. “I even called USMC EFMP HQ in Quantico because I asked why they sent me somewhere where there are no services.”

What has been your experience with EFMP? Sound off in the comments!