Why It Matters

Military families with special-needs dependents may face challenges accessing services through the TRICARE Extended Care Health Option (ECHO) program, according to the U.S. Government Accountability Office's (GAO) report GAO-26-108086. The report, publicly released June 1, 2026, examined whether families could obtain skilled nursing care, habilitative services, and respite care through ECHO and Medicaid. In GAO's review of 24 programs in seven states, 14 offered coverage for all three services it examined.

Some of the Medicaid programs reviewed covered more respite care than ECHO currently provides. Out of 734 ECHO authorizations approved for respite-care services from 2022 through 2024, fewer than one-third were used.

The Big Picture

The ECHO program provides eligible military families with special-needs dependents coverage for additional services beyond their TRICARE health-plan coverage. The ECHO Home Health Care (EHHC) benefit covers additional services for enrollees who are homebound with medically complex conditions. ECHO and EHHC provide coverage for habilitative services and respite care, while EHHC also covers skilled nursing care.

Military families with special-needs dependents may also qualify for home- and community-based services through their state Medicaid program. GAO conducted its review of Defense Department and Medicaid policies and documents in seven states with high active-duty military presence.

The review also examined access challenges for military families seeking these services through ECHO and steps the Department of Defense had taken to address those challenges, using interviews with Defense Department officials, TRICARE representatives, state Medicaid officials, and organizations representing military families and the special-needs community.

The Bottom Line

ECHO case managers said the lower use of approved respite-care authorizations was partly attributable to the program covering fewer respite-care hours. Defense Health Agency officials reported taking steps to increase ECHO respite-care coverage from 16 to 32 hours per month.

The Defense Health Agency plans to compare ECHO benefits with benefits offered through certain Medicaid programs, but it had not established goals or a timeline for completing that comparison. GAO recommended that the Defense Health Agency assess and document ECHO's coverage limit and adjust it as appropriate. GAO also recommended that the agency establish goals and a timeline for the Medicaid comparison and share the review's findings with Congress.

The two recommendations were listed as open, meaning GAO had not confirmed that actions satisfying their intent had been taken, although actions could be planned. The Department of Defense agreed with the recommendation on goals and a timeline but disagreed with the recommendation to assess the coverage limit, citing average ECHO utilization amounts from 2024.

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