The Psychological Burden of Using Military Benefits

Jennifer Barnhill is a writer for Military.com who writes about military families.

When I first moved to my husband’s current duty station, the woman on the other end of the Tricare West call center said that the local military medical facility (MTF) was full and was no longer accepting new patients. I was given the name and phone number of a local doctor and sent on my way.

After weeks of leaving unanswered messages, I finally got someone at the doctor’s office.

“I’m sorry, I know our website says we accept patients, but that’s outdated information,” said the receptionist.

I called Tricare and was assigned a new doctor, but was turned down again since the office was not taking new Tricare patients. It happened three times in total.

When I finally called Tricare West back after the third doctor rejected me, it had been so long that there was an opening at MTF. When I expressed my frustration at this run, I was told I needed to call another number to help update the list of Tricare providers. This was a psychological burden given to me because my husband had been ordered by the Navy to move to a new duty station.

I was lucky. My three children were quickly assigned to doctors, and no one in our family is medically complex. For those who must plan specialty or mental health care, going back and forth can be a full-time job. But is the psychological burden of using the benefits of war to be expected or an indication of a broken system?

“My son was registered with the CDC [military base child care]but because of his behavior problems and neurological problems, he was being kicked out almost every day,” said flight attendant Master Sergeant Rachel Kegley. When she told her pediatrician about her concerns, she was told her son would grow out of it. When she took him to his nursery physical three years later, the provider requested an evaluation. Psychiatry to hopefully give the family answers.

“We called all over town; nobody had any vacancies,” Kegley said. When she finally received her son’s autism diagnosis, Kegley turned to the Special Family Member Program (EFMP) for resources and support. But after the first call, she says she never heard back from the care coordinator. So, he kept making calls. “Most of them don’t take patients or they don’t take Tricare anymore. It’s the same as in pharmacies. You call and try to get medicine for your children, they don’t have it or they don’t take it. It’s very challenging.”

The concept of “mental load” or invisible work has proliferated in recent years, focusing on small but tedious tasks that are often neglected at home and at work and are disproportionately burdened by women — doctor’s appointments, babysitting. ‘ backpacks to make sure there isn’t a crumpled permission slip hiding under a rotten banana, etc.

It means sitting with a to-do list. They are the small jobs that keep the family working, but can be worn by the person who carries most of the “load.” When the already complex process of accessing benefits is combined with military bureaucracy, the psychological burden can increase dramatically.

“There are a lot of loopholes that we have to jump through, and we spend a lot of time applying for these things,” said Amanda Larimore, an Air Force spouse and parent of a child diagnosed with autism spectrum disorder.

Despite qualifying for supportive services, Larimore reports having difficulty accessing services such as respite care, a program that allows families to receive up to 20 hours a month of specialized care for physical and emotional disabilities. However, accessing this benefit can be difficult. Larimore reports that the leadership has been working on strengthening the network, but until then, the only providers available are in a different state, for a few hours.

Larimore was told there was a shortage of providers, but discovered that there were actually providers, none of whom participated in the respite care program.

Special Family Member Program families, like the Larimores, may have a more pronounced psychological burden. They have to fill out a lot of paperwork — military and civilian — and are often cared for by more than one doctor, which requires referrals and more chances of being on a waiting list. Families hope to be assigned to an institution that can take care of their needs, but this is not always the case.

“The families said that they have gone to places approved by EFMP, but because there are many EFMP families there, there is no service because all these services have already been done,” said Dr. Jennifer Kremkow, associate professor at Elmhurst. University. Kremkow has published numerous studies examining the experiences of military families whose children have autism.

“The thing that many parents were talking about was the challenge of managing it all, especially if their member is busy, if they are separated, or if they are being trained,” he said.

According to the Tricare for Kids Coalition (TFK), an organization that promotes access to health care for military children, the Air Force has been sending many EFMP families to Colorado Springs, Colorado, as a designated EFMP location. However, in October 2023, the Defense Health Agency reduced Tricare reimbursements by 40% for some outpatient services. Children’s Hospital Colorado in Colorado Springs then sued the Department of Defense over the change. Although EFMP families in the area have not reported disruptions, according to TFK founder Kara Tollett Oakley, the coalition is concerned about disruptions in access to care where high demand and low reimbursement make it challenging for providers to serve military families.

But it is not only EFMP families who face the psychological burden.

“Funding for the military has been a challenge and a headache,” said Jennifer O’Donnell, owner and operator of Uptown Children’s Academy who is also married to a retired Marine. Both the Military Child Care at Your Home and Child Care at Your Home programs provide financial assistance to military families who do not have access to military-run, but separately administered, child care. “I’ve had other parents stop because after six, seven months of sending the same things over and over, they just get to the point where they’re done.”

Aria Spears, an Army spouse who struggled to find childcare to keep her job, knows that battle firsthand. “We were working to find a baby [child care] nine months and I didn’t get anything, but finally today after I don’t even know how many calls, how many times we called the same place over and over again over the last few months, someone called me about this place,” said Spears. “But I quit my job two weeks ago because I think it’s impossible to get care of children.”

Access to affordable health and child care is a struggle for all Americans. However, research shows that military families report having a difficult time because of how often they need to return care. “Now we’re finding that, because these things exist in the public sector, like the lack of professionals and the wait times and frustration with how the system works, that’s used to justify a lot of the barriers that exist for military families,” Tollett Oakley said.

“The issue is the erosion of benefits that happens behind the scenes,” said Karen Ruedisueli, director of health affairs and government relations for the Military Officers Association of America. “If you’re looking at managing health care costs within Tricare, you can cut networks, you can cut coverage, you can increase copays for people. The cost increases are very visible to everyone.”

If childcare providers like O’Donnell or organizations like Children’s Hospital Colorado feel like the juice isn’t worth the squeeze, they can choose not to sign up as providers for military families. Because there is no cut, no cry to protect profit.

Families feel the psychological burden produced by the lack of providers and are reminded to “embrace breastfeeding.”

When delays, wait times and hold times are expected and not tracked, they can easily be dismissed as anecdotes. But if this “mental load” is followed, it may be a useful indicator of health and the true availability of military benefits.

— In addition to her reporting, Jennifer Barnhill is also the host of Military Dinner Table Conversations, a monthly retreat town hall with military families. He is the 2023 Bush Institute StandTo Veteran Leadership Program Scholareditor-in-chief of National Military Spouse NetworkCareer Connections Magazine, and military spouse link League of Wives Memorial Project.

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