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Federal Judge Rules for Military Families on ABA Coverage

WASHINGTON, DC (July 26, 2012) -- A federal judge in Washington has handed military families a major victory in their pursuit of insurance coverage for Applied Behavior Analysis (ABA) therapy for their dependents by ruling in a class action lawsuit that the Department of Defense's (DoD)  policy of limiting benefits to active duty members was "arbitrary and capricious."

U.S. District Court Judge Reggie B. Walton found that the DoD's policy of providing ABA coverage for active duty members through the ECHO program while denying it to retirees under the TRICARE Basic program  was "obviously contradictory" because both programs are governed by the same 'reliable evidence' standard. "It is well-established that laws conferring benefits to members of the Armed Services must be construed generously in favor of the nation’s military service members," Walton said in the opinion.

Walton's ruling came in Kenneth Berge v United States of America; the plaintiffs were represented by attorneys Dave Honigman and Gerard Mantese. An estimated 23,000 military dependents have autism. (Honigman and plaintiff Dawn Berge flank Lorri Unumb, Esq., Autism Speaks' vice president for state government affairs)

"This ruling is a huge victory for military families affected by autism," said Karen Driscoll, Autism Speaks' associate director of federal government affairs and military relations and a Marine Corps spouse. "The United States government has finally taken a step toward providing all men and women who have served our country with the health care Americans expect them to have."

Walton remanded the case back to the DoD "with instructions that ABA therapy coverage be provided to Basic Program beneficiaries who otherwise qualify for reimbursement and such reimbursement be provided in compliance with the applicable TRICARE guidelines for the expenses incurred by qualified beneficiaries to acquire ABA therapy for their children."

Autism Speaks has worked with the plaintiffs' attorney, while at the same time pursuing a legislative change that would guarantee ABA coverage is provided under TRICARE Basic. An amendment to the new DOD budget bill authored by Rep. John Larson of Connecticut was approved by the House. Action is pending in the Senate where Sen. Kirsten Gillibrand of New York is pressing for similar action.

"We will continue all of our efforts to make sure that military families get the services that they need and deserve," said Driscoll..