deployments, particularly since positive identification of an SUD may lead to separation from uniformed service. Thus, SUDs are sometimes viewed as personnel issues and at other times as medical conditions. As a result, both the Personnel and Medical Commands are involved in the identification and management of SUDs. Although the focus of military treatment facilities is operational readiness, the Department of Defense (DoD) for many years has expressed a commitment to providing substance abuse treatment to eligible beneficiaries.
This chapter provides an overview of the MHS. It describes the eligible beneficiaries, the direct care military treatment facilities, and the purchased care system. It also explains how service members and their dependents access SUD care and concludes with a summary.
To be eligible for health care services in the MHS, including those for substance abuse, one must be either a “sponsor” (generally the person who has served or is serving in the uniformed services) or the sponsor’s family member (spouse; dependent child under age 21 or under age 23 if a full-time student, or up to age 26 at additional cost1; or adult disabled child if disabled before age 21). Eligibility is determined by enrollment in the Defense Enrollment Eligibility Reporting System (DEERS), a computerized database of all beneficiaries eligible for health care and other uniformed services benefits (see Figure 3-1).
Military treatment facilities and the MHS in general are designed to ensure the operational readiness of the members of the uniformed services. Readiness is the ability of the uniformed services to be prepared for operational duties at all times. Readiness requires medical, dental, and mental health. DoD, in conjunction with the Department of Health and Human Services (for Public Health Service officers) and the National Oceanic and Atmospheric Administration (for NOAA officers), has a statutory responsibility to provide health care to identified beneficiaries. This care is provided through the direct care system at military treatment facilities and through the purchased care system by reimbursement to authorized providers via the TRICARE insurance plans (see Figure 3-2).
Members of each of the seven uniformed services (see Figure 3-3) have the same overall health care benefits under the TRICARE plans, which include coverage of behavioral health benefits such as substance abuse services. Further, members of the same beneficiary category (i.e., active duty, Guard/Reserve, retiree, family member) also have similar benefits across the different branches of the military, with the same TRICARE plans from which to choose.
1 TRICARE Young Adult, a provision of the 2010 Patient Protection and Affordable Care Act.