NICEVILLE, FLORIDA — TRICARE, the military's healthcare program, has declined to implement recommendations from a National Academies report published last September. The report affirmed that applied behavior analysis (ABA) therapy should be included as a basic benefit under TRICARE without excessive administrative barriers.

In 2021, TRICARE imposed new requirements for ABA coverage, which included stricter paperwork, mandatory assessments, and limitations on certain services. The updated rules also ended coverage for most ABA services provided in school settings and utilized autism services navigators to approve care plans.

Kristi Cabiao, a nonpracticing physician residing in Niceville, Florida, and mother to 10-year-old Logan Cabiao, organized a nonprofit called Mission Alpha in 2021. The organization aims to pressure TRICARE and Congress to restore broad ABA coverage. Cabiao lobbied Congress for an independent study on ABA therapy's effectiveness, which was launched in 2021 and conducted by the National Academies of Sciences, Engineering, and Medicine.

Logan Cabiao, who is covered by TRICARE through his retired Air Force pilot father, Mario Cabiao, has a severe form of autism and is nonverbal. He requires round-the-clock support and supervision, and is unable to perform basic tasks such as brushing his teeth or using the bathroom independently. TRICARE no longer covers his ABA sessions for basic activities like toothbrushing, handwashing, and getting dressed. "They said that's babysitting," Kristi Cabiao said, referring to a virtual Q&A she attended with the Defense Health Agency, which oversees TRICARE.

ABA therapy is designed to help children learn daily life skills and reduce harmful behaviors. Logan's parents sometimes sedate him for routine doctor's appointments, and he may run off without warning in crowded places. Mario Cabiao said Logan currently functions at the level of a 2-year-old. "Time is of the essence, and eight years is not a lot of time," he said, referring to the time until Logan turns 18.

The National Academies report, a 336-page document, stated that the evidence supporting ABA therapy is robust and meets the Department of Defense's criteria for reliable evidence. Last fall, several organizations, including the American Academy of Pediatrics, Autism Speaks, and Mission Alpha, signed a letter to Congress urging the implementation of the report's recommendations.

Alycia Halladay, Chief Science Officer at the Autism Science Foundation, stated that ABA is evidence-based. "ABA is evidence-based and it is based on science," Halladay said. "It makes me sick to think that military veterans and their families are getting less than what other people are getting." Medicaid and the Federal Employees Health Benefit cover ABA therapy for children, and most states mandate private insurers to cover the therapy or other behavioral interventions for children with autism.