Defense officials are currently coordinating with the Office of Personnel Management and aim to offer these accounts to eligible service members by Jan. 1, 2025, said Susan Mitchell, Department of Defense Tax Counsel, and executive director of the Armed Forces Tax Council.

As with DoD’s new dependent care flexible spending accounts, enrollment for the new accounts would be during this year’s open enrollment season from mid-November to mid-December, likely Nov. 11 to Dec. 9.

Those who participate can save an average of 30% of the cost of these unreimbursed expenses, according to the Federal Flexible Spending Account Program, known as FSAFEDS. Savings depend on each individual’s tax situation.

The Federal Flexible Spending Account Program, which also administers the service member dependent care flexible spending accounts, is sponsored by the Office of Personnel Management.

Eligibility rules likely will be similar to the rules for the dependent care flexible spending accounts for service members, Mitchell said — service members in the active component and Active Guard Reserve members on Title 10 orders.

These health care flexible spending accounts, already available to Defense Department civilians and to many employees in the private sector, will allow service members to set aside pretax dollars in an account. The money can be used to help pay for health care expenses that are not covered by Tricare or other health care. The maximum amount that can be set aside each year depends on the Internal Revenue Service annual contribution limits. In 2024, for example, the maximum is $3,200. The minimum is $100.

“While Tricare provides health insurance for service members and family members, the health care flexible spending accounts can help reduce the costs, the burden of paying out-of-pocket health care expenses,” said Mitchell.

The pretax dollars are deducted from the service member’s gross pay and deposited into the account.

The service member can then submit health care receipts to be reimbursed for things like co-pays for prescriptions and health care visits, orthodontia, contact lenses, glasses, prescription sunglasses, in vitro fertilization and more. Many over-the-counter items and medicines such as sunscreen, bandages and hearing aid batteries, antacids, allergy medicines, cold medicines and aspirin and other pain relievers are among the qualifying expenses, with itemized receipts.

Family advocates applaud the offering of the health care flexible spending accounts.

Eileen Huck, government relations senior deputy director of the National Military Family Association, said, “One of our goals is to reduce out-of-pocket expenses for service members and families.”

However, she said, advocates caution against a situation “where people could point to the HCFSA as a reason to increase health care costs.”

Mitchell advises service members and families who may be interested in participating in the health care flexible spending account to start tracking their unreimbursed health care expenses to get an idea of how much they spend during a typical year. Information and calculators are available at FSAFEDS.com

More information about Department of Defense’s specific program will be available later in 2024.

It also has affected some retail pharmacies across the country.

For the time being, officials ask for patience, “while pharmacies take longer than usual to safely fill prescription needs.”

Until the issue is resolved, military pharmacies will use a manual procedure to fill outpatient prescriptions, health officials said in a Thursday statement to Military Times. Priority goes to urgent prescriptions, followed by routine prescriptions.

More pharmacies rejoin Tricare network. Are there enough?

“Each military hospital and clinic will continue to offer pharmacy operations based on their local manning and resources,” officials said.

On Wednesday, Change Healthcare disconnected its systems to protect patient information.

“Once we became aware of the outside threat, in the interest of protecting our partners and patients, we took immediate action to disconnect our systems to prevent further impact,” stated Change Healthcare’s status web page.

The latest update said the company expected the disruptions to last at least through Thursday.

The company’s website states that it provides provides “industry-leading analytics, expansive data, and unparalleled connection and data transfer between providers, payers, and consumers.”

Any references that this is caused by a technical issue with MHS Genesis are “inaccurate,” military health officials stated. Genesis is the military’s electronic health record system.

Military pharmacies around the world have been posting notices about the issue and their procedures in response.

“This is impacting pharmacies at [military treatment facilities] enterprise-wide,” read a sign posted at the 19th Medical Group pharmacy at Little Rock Air Force Base, Arkansas, shared on social media Thursday. “We do not know how long it will be down. They are working to resolve it.”

At McConnell Air Force Base, Kansas, the 22nd Medical Group pharmacy posted on social media that it can’t process new prescriptions.

“However, our Pharmacy remains open and will continue to dispense already-completed prescriptions. If you need a new prescription today, please contact your prescribing physician and request that they send the prescription to an alternate pharmacy within the Tricare network.”

At Kadena Air Base in Japan, officials at the medical clinic posted on Facebook Thursday morning: “Due to a systems outage, pharmacy wait times may be longer than normal today.”

Members of the House Armed Services Committee’s readiness panel pressed Brendan Owens, the assistant secretary of defense for energy, installations and environment, for more oversight and accountability of barracks at a hearing Feb. 7.

“No one from [Defense Secretary Lloyd Austin] down to your level, down to the services, down to the base commander … nobody has actually been held accountable, correct? No one’s actually been relieved or fired?” asked Rep. Michael Waltz, R-Fla., chairman of the House Armed Services Committee’s readiness panel.

“Not that I’m aware of,” said Brendan Owens, assistant secretary of defense for energy, installations and environment. He and the services’ civilian officials responsible for overseeing installations testified before the panel.

“I would submit to you that may be a critical part of the problem,” Waltz said, adding that by holding people accountable, it would send a signal that the situation “unacceptable.”

Rep. John Garamendi, D-Calif., suggested that Congress should require that the base commander be accountable and responsible for the barracks, which is required with family housing.

The living conditions in barracks have been a persistent problem for decades. Auditors with the Government Accountability Office reported similar problems with barracks 20 years ago.

The lawmakers cited a more recent report from the Government Accountability Office, from September, which documented widespread barracks issues. All ten of the installations they visited reported mold infestations and “broken, malfunctioning, or non-existent heating, ventilation, and air conditioning systems.” A variety of other problems at individual bases have been highlighted in recent years, too.

“I don’t think anybody on this committee or any of you are expecting our service members to live in the Taj Mahal,” Waltz said. “But this is disgusting. This is unsatisfactory.”

Across the Defense Department, there are more than 850,000 bed spaces in unaccompanied housing, Owens said, in reference to permanent party barracks for service members stationed at a given base, as well as rotational spaces for those who are there temporarily.

He acknowledged the problems, and that the Defense Department has a lot of work to do. “The DOD has, in too many instances, failed to live up to our role in making sure the housing we provide honors the commitment of the service members and their families,” Owens said.

He said this year, the military anticipates implementing 28 of the 31 recommendations for improving barracks laid out by the Government Accountability Office in their September report.

Earlier in February, the Pentagon stood up a team to address improvements needed in service members’ living spaces, initially with a priority on unaccompanied housing and family housing or junior enlisted, he said. They’ll focus on making immediate, ongoing and urgent improvements to barracks; determining new configuration and habitability standards of barracks, and developing standardized preventive maintenance plans and schedules.

However, the age-old question is funding. Barracks compete for funding with everything else in the Department of Defense. Part of the problem is that the Defense Department doesn’t track how much of the sustainment funding that does make it down to an installation is actually used on barracks, the Government Accountability Office found, nor does the military reliably assess the condition of its barracks.

Owens told lawmakers that the Pentagon is working with the services on a new system that would help them track the condition of specific facilities such as barracks, look at the long-term prognosis for the facility, and account for the risk they’re taking if money doesn’t go to fixing that facility.

The services are working on a number of initiatives. For example, the Marine Corps has just ordered a “wall-to-wall” inspection of every barracks to assess the problems.

Should the military privatize the barracks?

The idea of privatizing barracks is gaining momentum.

“I would like to get the Department of Defense, as we’ve done with [family] housing, to the extent absolutely possible, out of the hotel management business. We have private sector entities that do it incredibly well at scale all over the world. And they would certainly go out of business in a second if any of their facilities looked like this,” Waltz said.

Could privatizing barracks help fix the lousy conditions?

Owens said the Defense Departmentis looking at privatization options as a way to meet some of the challenges facing barracks.

The Navy has two locations where unaccompanied housing has been privatized, San Diego, California and Norfolk, Virginia. Navy officials are looking at the feasibility of expanding the initiative to other Navy bases, said Meredith Berger, assistant secretary of the Navy for energy, installations and environment.

The Army has five privatization housing projects, mostly for senior enlisted members. Army officials have proposed a privatization project at Fort Irwin, in California that would provide 544 permanent party junior enlisted spaces, said Rachel Jacobson, assistant secretary of the Army for installations, energy and environment.

“That project will go a long way in helping us understand how and where privatization might be beneficial,” she said.

Garamendi, the ranking member on the readiness panel, said there are limitations on what each of the service branches can do regarding barracks privatization.

“We need to tell them to get on with it — in the next [National Defense Authorization Act], give them the authority to do so,” he said. “And along the way, we should require that they pay careful attention to all of the problems that were created in the family housing over the previous 30 years and to avoid those, and hire some really good real estate lawyers because you’re going to be up against some really good real estate lawyers who managed to screw the government in the previous 30 years on the family housing.”

“Where is the possible contamination even coming from? The public deserves to know,” said Rep. Jill Tokuda, D-Hawaii, during a hearing for the House Armed Services Committee’s readiness panel on Wednesday. “Our service members and their families deserve to know that their water is safe and clean to drink. The Navy has a public health responsibility to urgently get to the bottom of this and make sure people know that the water that they drink, that they give to their families, is safe.”

Tokuda said the Hawaii Department of Health has received about 50 complaints over tap water and air quality from people using the Navy water system. In addition, water samples that were tested in the fall had trace amounts of diesel.

“While the chemical signatures don’t correspond with the jet fuel that was stored at [Red Hill Bulk Fuel Storage Facility], where we had 19,000 gallons emptied into our drinking water system, impacting service members, their families and civilians, it is disturbing that we’re talking about chemical traces in our drinking water, “she said.

“We’re concerned, too,” said Meredith Berger, assistant secretary of the Navy for installations, energy and environment. “Any time that we hear there is a report of something that is wrong, especially when it comes to water, we are taking action and responding.”

The Navy has put together a team of scientists and communications experts to research the problem, and to share the information with residents, said Berger, testifying before the panel. Navy officials have visited the homes or locations identified and gathered information from those individuals, provided bottled water and have tested the water, Berger said. “Significantly, we have seen that every indication is below the 266 [parts per billion of Total Petroleum Hydrocarbons]” threshold for safe drinking water that the Hawaii Department of Health has set, she said.

However, she added, “there is something wrong, and we need to see what is causing people to report that they are having an impact.”

According to a Jan. 8 Navy press release, the results of tests of water samples ranged from nothing detected to 144 parts per billion for Total Petroleum Hydrocarbons (TPH). An analysis of each sample that showed Total Petroleum Hydrocarbons showed no signs of JP-5 jet fuel, officials said.

But Tokuda questioned the effects of even lower levels of TPH.

“We do not know what exposure to lower levels of TPH in our drinking water … what that could mean to both service members and their families, and to civilians that are being exposed through these water system leakages and whatnot,” she said.

“But at the end of the day,” continued Tokuda, “if there’s a sheen on your water, and a smell coming from it, would you pick up that glass and drink it?”

Meanwhile, a recent lawsuit filed alleging the Navy was negligent in its actions surrounding the fuel leaks in 2021 also alleges that there are ongoing problems with the water, citing reports from the Environmental Protection Agency in 2022 where traces of petroleum were found in three of four homes tested. In October 2023, the EPA investigators observed an oily sheen in the water and ongoing health symptoms, such as rashes, and called for inspections and sampling of water heaters and plumbing.

The lawsuit was filed Feb. 5 in federal court in Hawaii, with 2,212 military family members and civilians. Two other lawsuits were filed earlier with a total of 301 plaintiffs.

The lawsuit also cites data from the Navy’s continued testing of the water that showed continued detections of TPH in the Navy water system. According to Kristina Baehr, one of the attorneys representing families, more than 50% of the samples taken — 1,453 out of 3,045 in 2023 — detected TPH.

Toxic water consumes daily lives of many Hawaii military families, with no end in sight

All told, more than 93,000 individuals were affected when their water was contaminated in 2021 by the jet fuel spill at the Red Hill Bulk Fuel Storage Facility. There were 9,715 households in 19 different communities on the Navy water system of Joint Base Pearl Harbor-Hickam who were affected. They include residents of two Army communities and Air Force communities in the Hickam side. Some Hawaiian civilians were also affected, living in homes supplied by Navy water.

On Nov. 28, 2021, military families reported smelling fuel odors and seeing an oily film in their tap water. But some had reported mysterious abdominal pain, vomiting, memory loss, skin rashes, eye irritation, and teeth and gum issues even before the signs of fuel appeared. At first, Navy officials told residents it was okay to drink the water.

Since Dec. 3, 2021, the Hawaii Navy water system has been sourced only by the Waiawa Shaft. Water from the Waiawa Shaft, located 6.2 miles from Red Hill, is monitored to make sure it meets Hawaii Department of Health and Environmental Protection Agency standards for safe drinking water, according to the Navy.

The latest lawsuit highlights the experiences of eight families out of the 2,212 plaintiffs. Of those, 1,197 are filing medical negligence claims. The case is named for the Hughes family. Jaclyn Hughes gave birth to their third child in mid-November of 2021, and her Navy husband returned to Hawaii from Japan, where he was stationed, to be with the family.

But around Thanksgiving, their water had an oily sheen and smelled of gasoline. Their newborn son was covered in red rashes, and Jaclyn’s throat was sore and burned. Their middle child, 4 years old at the time, once with “a vivacious spirit, turned into a whirl of confusion and rage,” according to the lawsuit.

By February 2022, the child had become self-injurious and violent, clawing at her skin and pulling her hair out, according to the lawsuit. Costs piled up for the family, including costs of care and testing from out-of-network doctors. Plans to move to Japan to join her Navy husband became impossible, as the child’s new diagnoses, including level one autism spectrum disorder, made the family ineligible for orders outside the continental U.S. The husband was granted compassionate reassignment to return to Hawaii; and the family was reassigned for humanitarian reasons to California in 2023.

Now, the child has slowly stabilized, with support from an extensive care team, according to the lawsuit. “Despite this, the trauma experienced and fear of what the future holds has created suffering the family may never be able to escape,” the lawsuit alleges.

The Hughes family’s lawsuit, and two others allege that while the Navy has taken responsibility for the fuel leaks, they haven’t taken responsibility for failure to warn residents about the fuel release.

Meanwhile, the Navy is in the process of draining and shutting down the Red Hill Bulk Fuel Storage Facility. By November, the Navy had removed more than 104 million gallons of fuel, or 99.5% of the fuel previously stored there.

They have since removed about 25,000 gallons of residual fuel as the next step. The facility, which has been providing fuel to the military in the Pacific since World War II, had the capacity to hold 250 million gallons of fuel, but was at less than half the capacity.

The contracts are moving forward following a Jan. 31 decision in the U.S. Court of Federal Claims affirming the Defense Health Agency’s choice of TriWest Healthcare Alliance as the Tricare West Region’s new manager, denying a protest lodged by incumbent contractor Health Net Federal Services last year. The award, announced in December 2022, is worth up to $65.1 billion over nine years.

Humana Government Business, the incumbent contractor for Tricare’s East Region, will continue in that role under a new deal worth up to $70.8 billion. The new contracts for the two regions have a potential combined value of $136 billion over nine years.

Work has already begun to shift to the new contracts, said DHA spokesman Peter Graves. Officials began that 12-month transition by holding meetings with TriWest and Humana in January.

Tricare beneficiaries will continue to receive medical care under the current contracts with Health Net and Humana until the new contracts kick in next January.

The new generation of Tricare contracts is designed to improve care for the 9.6 million Tricare beneficiaries in the military health system. The contracts were set to start Jan. 1, 2024, before Health Net contested DHA’s decision with the Government Accountability Office and in the federal court system. The government paused work on both contracts, pending the outcome of the protest.

The changes intend to improve military readiness, health care delivery, clinical quality, patient safety and access to health care “while containing costs” for the Defense Department, Graves said. For instance, the new contracts will allow patients to transfer specialty care referrals to a new doctor when they move, even if their new duty station is not in their current Tricare region.

There are currently 2.8 million Tricare beneficiaries in the West Region. As part of the new contracts, an additional 1.5 million beneficiaries will transfer to the West Region from six states in the East Region: Arkansas, Illinois, Louisiana, Oklahoma, Texas and Wisconsin. The West Region will cover 26 states.

Boosting service members’ housing allowance to pay for 100% of those expenses, rather than the current 95%, would make a big difference for troops’ pocketbooks, the enlisted leaders told members of the House Armed Services Committee at a hearing Wednesday on the quality of life in the military.

“That’s a huge impact. That is 5% that goes back in the pockets of our service members so that they can pay for their housing,” Chief Master Sergeant of the Air Force JoAnne Bass said. “We’ve got to get there. That’s, to me, a no-brainer.”

Raising the housing stipend would also demonstrate to troops that the nation they serve cares about them, Sergeant Major of the Army Michael Weimer added.

The push for greater funding comes as the volatile real estate market has stretched many military families’ budgets and complicated their search for stable, affordable housing nationwide.

The Defense Department used to set Basic Allowance for Housing rates to cover 100% of troops’ projected housing costs, on average. The funding level has dropped to 95% since 2015, when Congress allowed it to pare back the financial help.

Rep. Don Bacon, R-Neb., who chairs the committee’s special quality-of-life panel, pledged to work on the issue as Congress crafts the next slate of annual defense policy and appropriations bills.

“We have to restore that 5%,” Bacon said during the hearing. “We may not be able to do it in one fell swoop, but we’re going to try to chip away at this and get it done, because I think it’s just a terrible mistake, what we’ve done to the service men and women.”

Each 1% increase in BAH would cost taxpayers about $220 million, he noted. The figure comes from a 2023 Defense Department analysis that found adding the entire 5% back into the housing stipend would cost taxpayers an additional $1.1 billion in calendar 2024. That’s on top of the $27.9 billion in BAH the Pentagon expects to pay about 1 million service members in 2024.

The amount that each service member spends to cover the last 5% depends on their pay grade and whether or not they have dependents. That out-of-pocket cost ranges from $85 to $194 each month, according to the Pentagon’s analysis.

At the same time, lawmakers have urged DOD to cover the full 100% on its own — a move the department can make without congressional approval.

Could troops get a 100% housing allowance Jan. 1? What that would mean

While the monthly BAH increase would apply to all who are eligible for the allowance, troops living in privatized housing wouldn’t see it because their entire stipend is typically paid directly to their landlord. The rent for privatized housing is set at the BAH rate.

Generally, about two-thirds of service members live in the civilian community rather than on a base. Service members may choose to rent or buy an off-base dwelling that costs less than the monthly BAH allotment and can pocket the extra money. If they choose to rent or buy a home that costs more than BAH will cover, the extra expense comes out of their own pocket.

In some areas where affordable, safe housing is scarce, troops have had to make choices about living in areas that are less safe, more expensive or farther from their installation.

The average cost of purchasing a home in the U.S. spiked from $383,000 to $492,300 between the beginning of 2020 and the end of 2023, according to a database maintained by the Federal Reserve Bank of St. Louis. Active listings of single-family homes, condominiums and townhouses fell from nearly 952,000 to about 714,000 in the same time period.

Defense officials have tried to mitigate the impacts of increased housing costs by adding some out-of-cycle, temporary BAH increases at the beginning of fiscal years 2022 and 2023, without raising the 95% cap. The department also began calendar year 2023 by offering troops saw a 12.1% larger stipend, on average — marking the largest year-over-year percentage jump in BAH in at least 15 years.

BAH rates increased by an average of 5.4% in 2024.

Meanwhile, the Government Accountability Office has reported that DOD needs to improve the way it calculates troops’ housing allowances. DOD is in the process of reviewing those procedures.

Judge Ryan Holte affirmed the Defense Health Agency’s decision to award the $65.1 billion West Region contract to TriWest in a federal claims court ruling late Wednesday, according to officials with Health Net Federal Services, the plaintiff in the case. A new generation of Tricare contracts is designed to improve care for the 9.6 million Tricare beneficiaries under their purview.

The judge’s ruling has not yet been made public.

In December 2022, defense officials announced they had selected Arizona-based TriWest Healthcare Alliance as the new manager of the West Region, unseating California-based Health Net Federal Services as the area’s civilian network contractor. The Defense Department also awarded Kentucky-based Humana Government Business a new contract to continue its role managing Tricare’s East Region.

DOD awards new Tricare contracts worth $136B to start in 2024

The new contracts for the two regions have a potential combined value of $136 billion over nine years. There are currently 2.8 million beneficiaries in the West Region. As part of the contracts, an additional 1.5 million Tricare beneficiaries will transfer to the West Region from six states in the East Region: Arkansas, Illinois, Louisiana, Oklahoma, Texas and Wisconsin. The West Region will cover 26 states.

Health Net protested the decision in the U.S. Court of Federal Claims last August, after lodging an unsuccessful complaint with the Government Accountability Office earlier in 2023.

The ongoing dispute has delayed some of the improvements beneficiaries were expecting to see in their medical care. The new contracts, for example, will allow patients to transfer specialty care referrals to a new doctor when they move, even if their new duty station is not in their current Tricare region.

Work on the contracts has been delayed since the bid protest process began in January 2023. Officials have said the contractor will need a 12-month transition period before formally taking over. DHA did not immediately respond to a request for comment, including on how the ruling might affect that timeline.

In a statement Thursday addressing the ruling, Health Net officials reiterated their “commitment to working with the Defense Health Agency toward a successful close” of their current contract, and said they will continue to serve Tricare West Region beneficiaries through the end of 2024.

“Beneficiaries should not experience any disruptions to their Tricare benefit during this period,” Health Net said.

Pentagon plans to fix chronically understaffed medical facilities

TriWest officials didn’t immediately respond to a request for comment.

TriWest previously held Tricare contracts in the western United States for 17 years, from the start of Tricare in 1996 through 2013. TriWest also holds a federal contract with the Department of Veterans Affairs to administer VA’s Community Care Network for Veterans.

“The company’s prior experience and performance places it in solid positioning for successfully administering the next generation” of Tricare contracts, TriWest said in a statement after winning the contract in 2022.

In earlier court filings, Health Net contended that errors in the Defense Health Agency’s evaluation of proposals resulted in “the illogical conclusion that TriWest — an entity that has not performed a Tricare [Managed Care Support] contract in nearly a decade and that has no existing Tricare network — had equally relevant and more favorable past performance than the successfully performing West Region incumbent who has received glowing performance assessments for years.”

The government responded in a November court filing that DHA “had rationally evaluated TriWest’s proposal to use its existing accredited federal network to help populate” its network.

Military health system in flux

The new Tricare contracts are in transition as the military health system tries to woo patients back to its doctor’s offices from the civilian sector. Stakeholders from patients to military medical providers to military leaders have reported myriad issues stemming from medical personnel shortages that have led to patients being unable to get the care they need, or delays in that care. A Nov. 29 Defense Department Inspector General report detailed how beneficiaries around the world have dealt with military medical provider shortages, few civilian network options and long wait times.

Deputy Secretary of Defense Kathleen Hicks in December directed sweeping changes to boost staffing at medical facilities and increase access to care for beneficiaries, hoping to return millions of patients to the military health system.

Senior enlisted leaders aired their concerns about access to health care at a congressional hearing Wednesday on quality of life for military families. The issues are complicated, said Master Chief Petty Officer of the Navy James Honea. Part of that, he said, is the lack of availability of care in the extended health network outside of military installations.

“We have to make a decision,” he said. “Can we continue to rely on the extended health network outside our fence line, or do we need to figure out how to better recruit, and bring those services back?”

Citing problems that have led to “chronically understaffed military treatment facilities and dental treatment facilities,” Deputy Secretary of Defense Kathleen Hicks has directed sweeping changes to boost staffing at medical facilities and increase access to care for beneficiaries.

“Our service members, their families, other beneficiaries and all those cared for by military medicine will be better served when we rebuild [military treatment facility] capacity,” Hicks wrote in a Dec. 6 memo entitled “Stabilizing and Improving the Military Health System.”

Hicks laid out a plan to grow the number of patients who receive care in a military treatment facility by 7% by the end of 2026, compared to the number of beneficiaries in December 2022. That would mean 3.3 million people would be using the MTFs in three years, according to Military Times calculations.

About 9.5 million beneficiaries are part of the military health system.

The push is driven by concerns about medical readiness as well as cost, Hicks said. DOD’s overall health care costs have risen as patients have migrated to the civilian sector. That decline in patients has also spurred the military services to seek private-sector training opportunities to keep their medical staff’s clinical skills current.

For more than a year, stakeholders from patients to military medical providers to military leaders have reported myriad issues stemming from medical personnel shortages that have led to patients being unable to get the care they need, or delays in that care.

If DOD loses more patients to the civilian medical system, military beneficiaries could face “significantly worse” surgical mortality rates, medical mortality rates and patient safety than in military treatment facilities, one Pentagon-funded study found.

Hicks’ memo came a week after a Nov. 29 Defense Department Inspector General report detailing how beneficiaries around the world have dealt with military medical provider shortages, few civilian network options and long wait times. The Defense Health Agency did not respond to the Pentagon watchdog’s recommendations.

Health officials reverse decision on pregnant women at Kadena Air Base

The Defense Department had planned to cut military medical billets before the coronavirus pandemic began. Congress put the brakes on that effort in the fiscal year 2023 National Defense Authorization Act, halting the plan for five years, and requiring a series of reports before any cuts are made.

The military health system has undergone a massive reorganization over the past four years, moving military clinics and hospitals under the Defense Health Agency’s control rather than that of the service branches.

To do so, Hicks noted, DOD “adopted a complex approach to managing the medical workforce.”

She acknowledged that the realignment of medical personnel, the challenging national health care economy, and DOD’s “ambitious private-sector care capacity assumptions” led to chronically understaffed medical and dental treatment facilities that, at times, can’t deliver timely care. Nor can they ensure that there’s a sufficient workload to maintain medical providers’ clinical skills, she said.

To attack the problem, DOD convened subject matter experts from across the department who decided the best solution is to convince beneficiaries to return to the MTFs and to maximize the medical education and training pipelines.

But getting people to return to their military doctors and dentists “requires a stable, predictable workforce sufficiently staffed, trained, and routinely available to provide health care to our beneficiaries,” Hicks said.

That has raised concerns among some family advocates.

“It seems like the plan is to simultaneously recapture beneficiaries while also still working out how to manage the medical work force across DOD and the services,” said Karen Ruedisueli, director of government relations for health affairs for the Military Officers Association of America.

“Looking at the memo, I’m concerned that they don’t yet have a proven approach to address the MTF staffing problem, yet there’s a recapture goal out there” to bring 7% of health care back to those facilities, she said. “Where does that 7% come from, and where do they go? Where are they going to go within the system that has acknowledged problems with staffing?”

“This could turn into a real recipe for problems with access to care for military families,” she added.

Increasing access

DOD officials don’t plan to ask any patients to change their health plan or their doctor, the department said in a release.

“The goal is to make the [Military Health System] more accessible, to make getting care at military hospitals or clinics the easiest, simplest choice,” officials said.

The five-page memo outlines steps DOD is taking to hit its goal. The undersecretary of defense for personnel and readiness is conducting a comprehensive review of all medical manpower and staffing, to include active duty, Guard and Reserve, civilian employees and contractors in military treatment facilities and dental facilities, operational units and other areas.

The director of the Defense Health Agency will identify the capacity of each military treatment facility and dental treatment facility to maintain the clinical readiness of active duty health care personnel. By June 30, and annually going forward, the director will assess and set military and civilian manpower requirements for each military medical and dental facility.

DOD will also rethink how it assigns military medical personnel to hospitals and clinics. The department plans to shuffle medical personnel to boost capacity at a few key locations by July 1, officials said.

“We’ll begin PCSing a number of health care professionals,” David Smith, deputy assistant secretary of defense for health readiness policy and oversight, said in the release.

Smith is leading the task force in charge of implementing the memo’s directives. “From there, we’re going to a phased progression of assigning these providers to military hospitals and clinics,” he said.

Assigning military medical forces primarily to military hospitals and clinics increases the predictability and continuity for patients, as well as capacity for day-to-day health care, he said.

Since Jan. 1, the undersecretary of defense for personnel and readiness has been required to have a process for notifying the Defense Health Agency when uniformed medical or dental personnel will be unavailable at military facilities because of operational or readiness requirements, according to Hicks’ memo.

They’ll also implement authorities that allows the Pentagon to better recruit and retain civilian medical staff.

Lester Martinez-Lopez, the DOD assistant secretary for health affairs, also acknowledged the problems in a message to those in the military health system.

“I hear you. I know we have serious issues, and we have a plan to fix our situation. I am asking for your support during the time it will take to make the changes we need,” he said.

More possible fixes

Ruedisueli suggested several other steps defense officials could take to help military families, including a possible pilot program allowing them more flexibility in switching Tricare plans. That could help families navigate the limited capacity plaguing some military treatment facilities and civilian providers who accept Tricare insurance, she said.

“Beneficiaries really need to be able to switch plans to get the appointments that are available, and right now they can’t do that except in the annual open enrollment period,” Ruedisueli said.

For example, if a family in a Tricare Prime plan can’t get appointments at their military treatment facility, they aren’t able to switch to Tricare Select, which offers providers in the local civilian community. Similarly, if they’re in Tricare Select and the local civilian providers can’t meet their needs, they can’t switch to Tricare Prime to seek care at a military treatment facility.

Defense Health Agency officials also need to establish a digital system that allows families to report problems with access to care, such as having difficulty making an appointment, Ruedisueli said. Such a system could help beneficiaries make appointments while adding transparency and flagging problems to officials, she said.

“We know the military health system is committed to delivering beneficiary care, but they can’t fix problems they don’t know about. We need a system that allows families to raise those problems when they occur,” she said.

Most USID cardholders — including military retirees, reservists, spouses and dependents of U.S. service members — can file their requests online and receive new IDs by mail, defense officials said Jan. 16. The move expands a pilot program that began in February 2023 to allow uniformed sponsors with a common access card to request online renewals of USID cards.

The IDs are used to enter Defense Department facilities and to access benefits like health care.

DOD issues about 4.5 million ID cards each year, about 2.5 million of which are USID cards. Of those, around 1 million USIDs are eligible for online renewal.

For now, online renewal is limited to those who live in the United States, but officials are working to expand it to non-U.S. addresses as well. People whose IDs have expired and those seeking their first ID card are also ineligible for online services.

Allowing more beneficiaries to renew their IDs online frees up the pass and ID offices for active duty military and civilian government employees who need to apply for or renew a CAC, officials said.

To request an online renewal, the sponsor must be able to log into the ID Card Office Online as a CAC holder or have a DOD Self-Service Logon username and password. Make sure to read the instructions on how to set up a DS Logon account when creating a new profile. Sponsors will request the renewal by clicking the “Family ID Cards” tab on the ID Card Office Online landing page.

According to DOD, other requirements include:

• The USID card being renewed must be active, not expired. Children are eligible for online USID renewal if they have an active USID card.
• The sponsor and the cardholder must have email addresses listed in the Defense Enrollment Eligibility Reporting System (DEERS). You can check your data in DEERS to make sure it’s up to date.
• The cardholder must have a photo saved in DEERS that was taken within the last 12 years.
• The cardholder must have a current U.S. address in DEERS. Cards can’t be mailed to P.O. boxes.

Once the request is processed, a new card will be created and mailed to the card recipient at the address listed in DEERS. The sponsor and the cardholder will receive an email once the card is shipped, directing the sponsor to acknowledge when they’ve received the card. Once the sponsor acknowledges receipt, the new USID card will be activated and the old one will be deactivated.

The deactivated card should be returned to the government, to the nearest Real-Time Automated Personnel Identification System (RAPIDS) site, or mailed to: DMDC-DSC, Attn: USID Card Returns, 2102 E. 21st Street N, Wichita, KS 67214.

Service members can be reimbursed up to $2,000 for one dog or cat for each permanent change of station move to or from the continental United States, or $550 if moving within the lower 48 states. PCS orders must be effective on or after Jan. 1, 2024.

Here are the rules to get reimbursed for shipping a pet in 2024

Transporting pets during PCS moves has become increasingly difficult and expensive for military families over the past few years. Lawmakers sought to help alleviate that burden by authorizing reimbursements in the fiscal year 2023 National Defense Authorization Act.

Now, troops can seek reimbursement for costs related to mandatory microchipping, quarantines, boarding, hotel service charges, virus immunity testing and pet licenses at the new duty station. The Pentagon can also reimburse the cost of shipping a pet via air, if the service member flies rather than drives, or if the pet is shipped separately from its owner.

The Defense Department’s Joint Travel Regulations lay out the general rules for reimbursement of “reasonable and substantiated costs” during a permanent move. Troops must provide the required receipts to get their money back, but the services may require additional documentation, according to the Defense Travel Management Office’s website.

Troops will use the form DD 1351-2 to claim pet expenses, and they’ll be paid when the travel claim is settled. Service members must be on PCS orders; the benefit is not retroactive.

When transoceanic travel is involved, according to the Joint Travel Regulations, service members must use government-run or federally contracted transportation to ship their pet, if it’s available. If that’s not an option, defense travel officials added, service members must get what is called a “non-availability letter” in order to be reimbursed for travel they book separately.

Those letters state that a government ride for a pet wasn’t available, and are issued by the office processing the transportation request. Service members should contact their transportation office for more details, according to defense travel officials.

The Department of the Air Force on Jan. 4 became the first of the military branches to announce more specifics about what troops need to recoup pet shipping costs:

• All receipts related to pet travel must be provided and itemized, and indicate which pet they are for. They should include the name of the pet, if possible, especially for specialized care such as pre-travel vaccinations. All receipts must be provided, including those for expenses under the typical reporting threshold of $75.
• If the pet is flying cargo because it exceeds the weight limit for traveling by government-run or contracted transportation, the receipt must include the pet’s weight.
• All documentation used to get a non-availability letter, proving a lack of government transportation, must be included when the service member files for reimbursement.

According to Air Mobility Command, travelers using AMC Patriot Express government-contracted flights will get a receipt for their pet travel fees when checking in for a flight.

The Navy and Marine Corps don’t require any additional documentation outside of the Joint Travel Regulations, service officials told Military Times.

The Army expects to soon publish their own guidance explaining the claims and documentation process for reimbursing soldiers, said Army spokeswoman Lt. Col. Ruth Castro. Until that guidance is published, soldiers should “refer any questions to their chain of command,” she said.

Defense travel officials stress that costs can only be reimbursed for one pet. If service members pay to ship more than one household pet, they can choose which pet costs to claim for reimbursement. However, if a dual-military couple is traveling on separate PCS orders, each may seek reimbursement for one household pet — meaning two pets could be covered in total.

Although the law allows DOD to reimburse up to $4,000 in relocation-related costs per pet, per PCS move to or from overseas, defense officials capped the maximum repayable amount at $2,000 and delayed the policy’s implementation until Jan. 1, 2024.

The Marine Corps said in a June 9 memo that “significant unbudgeted costs” had prompted the Defense Department to delay the benefit after it became law in December 2022.

Realizing the financial hardship military families face to transport their pets around the world, the military relief societies have stepped up to help service members with the cost. Army Emergency Relief and the Navy-Marine Corps Relief Society have spent about $3,000 per client, on average, to assist with pet travel.

For more information, service members can contact:

• Air Force and Space Force: Local finance office
• Navy: Human Resources Service Center at 833-330-6622, or askmncc@navy.mil
• Marine Corps: usmcpassengertravel@usmc.mil
• Army: For now, the local chain of command

The fiscal year 2024 National Defense Authorization Act allows Defense Department health officials to waive out-of-pocket costs for the first three outpatient mental health visits each year for active duty families using Tricare. It also expands non-medical counseling services for military families through the Military and Family Life Counseling Program.

But the Defense Department hasn’t yet decided whether to make the cost cuts a reality for the more than 1.5 million active duty family members who could benefit from the new law. The Defense Health Agency is reviewing the provision and “has not made any decisions regarding its implementation,” said spokesman Peter Graves.

The provision says the defense secretary “may” waive the costs of certain mental health services for military families, but doesn’t require the Defense Department to do so.

If the Pentagon carries out the law as written, it would expand the military’s access to mental health care amid a nationwide shortage of providers and appointments.

The provision that allows DOD to waive out-of-pocket costs for three mental health visits applies to active duty families using Tricare Select, which currently requires a co-pay of $31 or $38 for mental health outpatient care per in-network visit.

The $38 in-network co-pay in Tricare Select applies to family members classified in “Group A” — those whose sponsor entered the military before Jan. 1, 2018. Beneficiaries in “Group B,” whose sponsor entered on or after Jan. 1, 2018, have a $31 co-pay for mental health outpatient visits under Tricare Select.

The provision also applies to active duty families in Tricare Prime, who aren’t subject to a co-pay unless they seek non-emergency care without a referral — known as the “point-of-service” option. Whether the cost waiver would apply to point-of-service options depends on how defense officials implement the law.

Active duty members, who must enroll in Tricare Prime, pay nothing out of pocket for their health care.

Eileen Huck, senior deputy director of government relations for the National Military Family Association, said the organization supports the provision but wishes the law did more to reduce the cost of accessing mental health care.

”Three visits might be enough for some patients sometimes, but the majority of time people are going to need more than three mental health visits,” Huck said. “We’re concerned that costs will continue to be a barrier to accessing care.”

In addition to active duty families, the new law also offers the waivers for those in a Tricare Young Adult health plan. Those family members are unmarried, adult children of an eligible sponsor, who are at least 21 years old but not yet 26, can’t enroll in an employer-sponsored health plan through their own job, and aren’t otherwise eligible for Tricare coverage.

The wording of the law creates an odd twist for this new benefit, Huck said.

“Most Tricare Young Adult beneficiaries are retirees’ kids, so they will be eligible for the three mental health visits with no co-pay,” she said. But other members of the same retiree’s family, including parents and younger siblings, wouldn’t be eligible.

“However, we appreciate that Congress has recognized the cost burden of Tricare Young Adult as well as the mental health challenges faced by so many young people, and has acted to make mental health care more affordable for them,” Huck said.

The law empowers military families to receive the treatment they need, said Sen. Jon Ossoff, D-Ga., in a press release about the bipartisan provision.

It “will expand free access to counseling and mental health services for military families, who make great sacrifices for our nation, endure great stress in so doing, and deserve nothing less than the care they need when they need it,” said Ossoff, who introduced the language with Sen. Kevin Cramer, R-N.D.

Services detail plans to beef up mental health services for troops, families

More non-medical counseling

The law also expands non-medical counseling available through the Military Family Life Counseling Program, run through the DOD family policy office, separate from the defense health program. The law allows these licensed mental health care professionals, including DOD civilian employees and contractors, to provide non-medical counseling in person or online, regardless of where they are located.

These professionals offer free short-term, confidential counseling on issues like deployment adjustments, stress management, moving preparations and getting settled afterwards, improving relationships, work problems and grief.

The new law allows counselors to work with families in any state, not only in those where they are professionally licensed. Those licensing restrictions made it more difficult to fill counselor positions in certain locations, prompting military family advocates to push for change.

“There’s a recognition that non-medical counseling has to be a big part of the mental health equation, that there just aren’t enough health care providers, and that [Military Family Life counselors] provide really valuable services,” Huck said. “I think DOD and the services are really pleased with the MFLC program, and by expanding the locations where they’re able to practice, it’s going to make a big difference in making the program more available to more families.”

The counselors serve active duty, National Guard and Reserve troops, as well as their immediate family members or their survivors. They work in military communities at local units, family centers and in other locations, such as some military-run schools and some civilian schools in military communities. They provide counseling for individuals, couples and groups.

Nearly half of the military spouses who participated in DOD’s 2021 survey of active duty spouses reported using counseling during their spouse’s career. About 1 in 5 spouses reported using counseling services within the previous six months.

Defense officials will rely on the 2024 survey’s findings to make decisions that best meet spouses’ needs, Patricia Montes Barron, deputy assistant secretary of defense for military community and family policy, said in a release Wednesday. The confidential poll will remain open for about eight weeks.

“We strongly encourage all active duty spouses to take a few minutes from their busy days to complete the 2024 Survey of Active Duty Spouses, so we can hear directly from them about what is and isn’t working,” Barron said.

The biennial survey gathers spouse perspectives on their satisfaction with military life, employment, relocation, child care and the overall health and wellbeing of military families. This year’s poll also expands sections on remote work and financial stability.

Spouses can participate in the survey in one of two ways, Defense Department spokesman Bob Ditchey told Military Times. The first is as part of a scientific study involving about 74,000 randomly selected active duty spouses, who will receive invitations by mail or email to respond to a longer version of the survey. That version of the poll can take up to 20 minutes to complete, the Pentagon said. Invitations will include a QR code to reach the survey online.

A second option offers a shorter version of the survey, which takes about five minutes to complete and is open to people who are not part of the study sample, Ditchey said. All spouses can visit the survey portal at dodsurveys.mil and enter their DOD identification number to find the version that applies to them.

Eligibility is verified through the secure portal, but no personal information will be linked to survey responses.

The Pentagon has periodically surveyed active duty spouses since 1985. In 2021, officials broadened the pool by starting to solicit input from any spouse who is verified, in addition to those invited through traditional scientific sampling.

The questionnaires shed new light on what matters most to military families. For instance, the results of the 2021 spouse survey provided new details on food insecurity among military families. Nearly half of the junior enlisted spouses who responded said they had experienced food insecurity.

While several organizations offer nonscientific surveys of the military community online, official Defense Department surveys collect input that is verified as coming from slices of the military community — in this case, active duty spouses.

DOD also runs separate quality-of-life surveys for active duty and Reserve component troops as well as Reserve component spouses.

The actual start date remains up in the air, as a protest involving the West Region’s $65.1 billion contract continues in the United States Court of Federal Claims. A 12-month transition period is needed before the policies begin. Defense officials, however, halted work on the contracts pending the decision of the court.

Defense Health Agency officials have said there will be no disruption to patient care, but the ongoing dispute could delay some of the improvements beneficiaries were expecting. The new contracts, for example, would allow patients to transfer specialty care referrals to a new doctor when they move, even if their new duty station is not in their current Tricare region.

New contracts for the Tricare East and West regions have a potential combined value of $136 billion over nine years. Once the dispute is settled, an additional 1.5 million Tricare beneficiaries will be transferred to the West Region from six states in the East Region.

In court filings, West Health Net Federal Services contends that errors in the Defense Health Agency’s evaluation of proposals resulted in “the illogical conclusion that TriWest — an entity that has not performed a Tricare [Managed Care Support] contract in nearly a decade and that has no existing Tricare network — had equally relevant and more favorable past performance than the successfully performing West Region incumbent who has received glowing performance assessments for years.”

In August, the Government Accountability Office denied a second protest by West Health Net Federal Services and affirmed defense health officials’ selection of the Phoenix-based TriWest Healthcare Alliance Corp. as the new managed care support contractor for the Tricare West Region.

In a court document filed in November, the government responded that the Defense Health Agency “had rationally evaluated TriWest’s proposal to use its existing accredited federal network to help populate” its network.

It’s the gift that keeps on giving for roughly 6 million current and former federal employees as many are looking to file for retirement in the coming weeks or organize their finances in preparation for tax season.

The TSP has been around for decades and has been cited as one of the unique benefits of working in the public sector. In a 2023 survey conducted by the Federal Retirement Thrift Investment Board, 82% of participants reported being satisfied with the TSP, though that figure has fallen over the last three years.

Those in the newer Federal Employees Retirement System get matching contributions up to 5%, while those who retired under the Civil Service Retirement System receive no match but can still contribute.

Thrift Savings Plan rule change aimed at spurring savings growth

Overall, the TSP managed $726 billion in assets as of September 2022, the latest year for which data is available.

Here’s how the TSP did in December:

— The S fund, which aims to match stock indexes comprised of small and medium-sized U.S. companies, performed the best last month with returns of 10.45%. While still in the green, the government securities investment, or the G fund, grew the smallest at 0.39%.

— Year to date, the C fund has the highest return of 20.8% and the G fund has hovered around 4%.

— Each of the ten lifecycle, or L, funds also improved in December, as they did in November.

As the IRS prepares to begin tax season on Jan. 23, here are some reminders for TSP account holders:

In November, the agency announced contribution limits for 2024, which increased to $23,000 for regular contributions and an additional $7,500 for catch-up contributions for those 50 and older.

And recall that any withdrawals taken Dec. 28 or 29 count as taxable income for 2024.

Additionally, employees who wish contributions to begin on the first pay date of 2024 had to have made their TSP selections for pay period 26, which ended Dec. 30.

The power of dollar-cost averaging for Thrift Savings Plan investors

In 2024, there will be 26 pay dates.

For annuitants anticipating 1099-R tax forms from the government, the Office of Personnel Management traditionally mails those out by the end of the month, but beware that you may not receive it until February, depending on delivery times.

In the past, OPM has said retirees can sign in to their online retirement services account starting the third week in January to digitally access their tax form.

Changes aimed at smoothing military moves are delayed while officials try to ensure two new systems — the government’s MilMove and the new contractor’s HomeSafe Connect — can operate together. Testing designed to iron out lingering challenges will run through the end of January.

The contractor, HomeSafe Alliance, was supposed to be ready to facilitate moves in September 2023. The Pentagon wanted to use the new system to move all domestic shipments by peak season 2024, which generally runs from May to Labor Day.

That time frame has been pushed back, and the military hasn’t determined when it will begin a phased implementation for moves at a limited number of locations. The rollout is expected to pause during peak season.

HomeSafe Alliance’s three-year contract aims to solve longstanding problems for service members and families whose belongings are too often lost or damaged during moves.

HomeSafe will be fully responsible for DOD moves, officials said, ideally creating a more transparent and accountable process of assigning a moving company to a household; packing, hauling and unloading their possessions; and handling any loss or damage claims. TRANSCOM will continue to oversee the program.

The moving company customer satisfaction rate among troops and their families was 78% in 2023, according to Andy Dawson, director of the Defense Personal Property Management Office at TRANSCOM. Customer satisfaction regarding claims for loss and damage, meanwhile, sat at just 41%.

“That’s tens of thousands of service members and families that aren’t satisfied with their relocation experience,” Dawson said. “We owe it to them … to do everything we can to improve the quality of life that our service members and families deserve.”

Lawmakers earlier this year backed plans for a 5.2% pay raise for all service members on Jan. 1, the largest annual pay raise in 22 years. The boost is not a result of congressional or executive branch generosity, but instead reflects the federal formula tying military salaries to civilian pay trends.

By that formula, the 2025 pay raise for troops should be 4.5%, the third consecutive year of pay hikes above 4% for military members.

White House officials or members of Congress could change that increase in their budget battles over coming months, either raising it to make up for higher cost-of-living concerns or dropping it to save money for other military priorities. But that has not happened since the early 2010s.

Pay boosts for junior troops not yet a priority for Pentagon planners

Lawmakers are more likely to keep the 4.5% raise mark and instead focus on targeted increases for troops with high-demand skills and junior enlisted personnel, a group whose annual base pay typically does not top $30,000.

Last summer, House Republicans advanced legislation to guarantee that even the lowest-ranking service members make at least $31,000. But the legislation was opposed by the White House, in part because of questions surrounding the cost and the other compensation those troops receive — things like housing stipends and enlistment bonuses.

Rep. Don Bacon, R-Neb., chairman of the House Armed Services Committee’s special military quality of life panel, has said he plans to make the junior enlisted pay issue a key focus of the committee’s work on the annual defense authorization bill this summer.

Pentagon leaders have pushed to postpone the debate until they complete their Quadrennial Review of Military Compensation, a periodic review of troops’ pay and benefits. But work from that group isn’t expected to be finished until January 2025. Bacon has said the issue needs to be addressed sooner.

Work on the authorization bill is expected to start in February, but delays in Congress passing a full federal budget for fiscal 2024 could delay some of those hearings and debates.

Military families also know that sometimes the best way to bring back the holiday spirit is to give to others. One sure-fire way is bringing gifts to children, whether it’s at holiday gatherings, “adopting” a family, or air-dropping packages to islands in the Pacific. Often, local military chaplains are involved in getting toys and food to military families in need during this season. Many in the military community are involved in the Marine Toys for Tots Foundation’s annual toy drive.

From Santa tracker to toxic Yule logs, agencies embrace the holidays

A number of organizations have programs for troops and military families throughout the year. These are just a few examples of what’s been happening.

Troops around the world still enjoy holiday meals

For those deployed to Northern Europe in response to Russia’s invasion of Ukraine, the Defense Logistics Agency has sent at least 940 whole turkeys, 7,520 pounds of roast turkey, 16,435 pounds of beef, 9,738 pounds of ham, 228 pounds of shrimp, 161 cans of sweet potatoes and 11,539 pies and cakes.

For those deployed to Iraq, Jordan and Kuwait, 947 whole turkeys, 13,632 pounds of roast turkey, 27,602 pounds of beef, 7,401 pounds of ham, 8,467 pounds of shrimp, 1,110 cans of sweet potatoes, 14,253 cakes and pies, and 3,744 containers of eggnog were delivered to the region, officials said.

Planning for the worldwide holiday feeding of troops begins months in advance at the Defense Logistics Agency. At publication time, agency officials were still finalizing their numbers for the Christmas food poundage sent worldwide.

Troops and families all over the world participate in events in their communities

On Dec. 12 in Powidz, Poland, soldiers with the 3rd Division Sustainment Brigade, 3rd Infantry Division made Christmas tree decorations with students during a holiday party at the Powidz school. They learned about local holiday customs, played games, and enjoyed some traditional holiday treats with the school children.

“Drops” of toys and other gifts have been happening around the world, too

In early December, six C-130 aircraft lifted off from Andersen Air Force Base, Guam, in Operation Christmas Drop 2023, to deliver 210 parachuted bundles of donated items such as nonperishable food, toys, fishing supplies, schoolbooks and clothing to more than 42,000 islanders on 58 remote islands throughout Micronesia, covering about 1.8 million miles in six days. Pacific Air Forces, partner nations, and the University of Guam work together on the yearly event. Operation Christmas Drop’s first flight was in 1952, and it’s the Defense Department’s longest running humanitarian and disaster relief mission. Donations are collected on Guam and through the Operation Christmas Drop private organization.

Other toy missions have been happening with units based at installations such as Fort Liberty, North Carolina, and Fort Moore, Georgia.

Giveaways and charity events help provide enriching holiday experiences for service members and their families

More than 700 families of fallen military — to include 1,800 family members — spent five days the first week in December at Walt Disney World Resort, Florida, at a healing retreat. All their expenses are paid by the Gary Sinise Foundation, their partners and donations from the public. The families could participate in many workshops and activities, in addition to enjoying all four Walt Disney World theme parks. The Gary Sinise Foundation officially took over the Snowball Express program in 2017.

A number of efforts are focused on deployed service members too. More than 45,000 holiday stockings stuffed with various goodies were pledged this year in the nonprofit Soldiers’ Angels “Holiday Stockings for Heroes” campaign for deployed service members, hospitalized veterans, and National Guard and Reserve members around the country. In addition, through Soldiers’ Angels’ Adopt-A-Family program, donors adopted more than 2,000 military and veteran families and supported them with presents and grocery gift cards.

Operation Ride Home works with Jack Daniel’s partners with Armed Services YMCA to help active duty junior enlisted and their families travel home for the holidays. This year the program was slated to help more than 2,000 junior enlisted troops and family members make the trip home to see their loved ones. They provide subsidized plane tickets and prepaid gift cards for road travel to help offset expenses. Jack Daniel Distillery has donated $100,000 for this year’s trips, and the general public also donates. This marks the 13th year the distillery has offered the program.

Operation Homefront’s Holiday Toy Drive is designed to relieve financial stress for junior and mid-grade enlisted families, grades E1-E6. Toys and holiday meal kits are distributed at various events. Dollar Tree has helped collect toys in their stores for military children for 17 years; the program distributed about $6 million worth of toys to military families nationwide in 2022.

Armed Services YMCA also works to help financially strapped enlisted families with food and toys during the holidays and all year. Since 2004, through donations to Operation Holiday Joy, more than 320,000 toys and more than 25,000 baskets of food have been provided over Thanksgiving and Christmas for junior enlisted families in need. Many of their 12 branches around the country have participated in this program, and the events vary from branch to branch. Military parents can go in and “shop” for gifts for their children for the holidays.

The number of residents living at the Armed Forces Retirement Home system has declined in recent years, as has revenue, even as expenses continue to increase, according to a recent Government Accountability Office report on the program, known for short as AFRH.

The Armed Forces Retirement Home is the only federal retirement home of its kind. It consists of two campuses in Washington, D.C. and Gulfport, Mississippi. To be eligible, veterans must have spent more than half of their time in the service as an enlisted member, warrant officer, or limited-duty officer, among other criteria.

Its operations are financed by resident fees, deductions from the pay of currently serving enlisted troops, warrant officers and limited duty officers, fines and forfeitures from military personnel who have disciplinary violations, investment interest income on the trust fund, gifts and other sources.

Among other prescriptions, the GAO recommends that Congress require the Defense Department increase the monthly 50-cent deduction taken from the paychecks of all serving enlisted personnel to fund the homes.

The recommendations come as the retirement homes struggle to increase revenue on their own. In October, AFRH officials scrapped a plan that was designed to bring in more income.

That plan sought to partner with the private sector to develop AFRH’s Washington-based property to generate millions of dollars in income from underused grounds and facilities.

But the project faced tough economic conditions between rising interest rates, inflation, supply chain challenges, and a struggling office market in D.C., officials said.

“It was clear that the financial benefit to the Home was now significantly diminished and the terms of the long-term lease were riskier to AFRH,” John RisCassi, the Home’s Chief Operating Officer, said in an October statement.

AFRH remains open to future collaboration, officials said.

IG: Pentagon failed to address financial problems of Armed Forces Retirement Home

Continuing financial struggles

The GAO’s findings aren’t new, as the retirement homes have faced financial struggles for at least the past decade.

AFRH is financed through a dedicated trust fund, but the balance in that trust fund dropped from $186 million at the end of fiscal 2010, to $46 million at the end of fiscal 2015, with officials citing building repairs and improvements costs, increasing expenses and declining revenues.

By 2022, the trust fund balance had been built back up to $107 million, largely because of infusions of taxpayer dollars — starting with $20 million in fiscal 2016, increasing to $25 million of taxpayer funds in fiscal 2022.

But the GAO report warns the trust fund is on track to being exhausted within 20 years without a “significant effort to bolster it.”

Agency officials agreed that significant steps are needed to fortify the trust fund, and stated in their 13-page response to GAO that they are proud of accomplishments over the last few years, such as increasing operating efficiencies and some revenue initiatives, even in the midst of the pandemic.

GAO auditors recommended that AFRH develop and implement policies and procedures for making better financial projections, build a plan for increasing occupancy levels at both campuses, develop and implement policies for estimating the cost of deferred maintenance and update its financial management policy.

Officials have been updating their financial policies and procedures and have been updating their admissions procedures as well.

AFRH officials have requested $68 million for operating expenses for fiscal 2024, and $8.9 million for maintenance and improvements, according to their budget justification documents. Those combined amounts include a $25 million boost of taxpayer funds. AFRH has been averaging revenues of about $47 million a year.

Here's why the Armed Forces Retirement Home is slowing down its planned fee hikes

Declining numbers of residents

While AFRH costs are increasing, the two homes are being used less as well, according to the GAO.

The occupancy rate has declined by 40% at the two campuses combined, according to GAO, shrinking from 1,028 residents at the end of fiscal 2014 to 611 at the end of 2022. The two campuses have a combined capacity of 1,120.

During that period, the occupancy rate at the historic Washington campus decreased from 85% to 38% capacity. AFRH officials told the GAO that they had purposely kept occupancy low as they prepare for a major renovation of one of the residential buildings. And the outlook is improving, as the number of admissions have picked up this year over the two campuses, they said.

Officials noted that “herculean mitigation efforts” were undertaken during the COVID pandemic, resulting in no resident deaths directly related to the pandemic. But the pandemic also had a major impact on occupancy, with about one-fifth of the number of new residents admitted in the first year of the pandemic compared to prior years.

One action the new leadership took was to raise residents’ fees, as has been recommended in a number of studies.

AFRH residents pay fees based on their level of care, and as a percentage of their monthly income. Veterans generally must enter AFRH at the independent living level. At that level, they pay a fee of almost 47 percent of their income, which includes all the amenities provided, from their residential space to three meals a day, wellness and community services, and health care. Those in memory care, the highest level of care, pay 70% of their income in monthly fees.

GAO auditors noted that across all levels of care, the average overall residential fee at AFRH is less than $1,900 a month. In comparison, they cite American Council on Aging statistics of the nationwide average for all levels of care at a life plan community as being more than $7,300 per month. AFRH officials agreed that their resident fees are lower than market, but also note that comparisons often fail to take into account average resident incomes, which may be lower in the veteran community.

Married couples can now apply to live at the AFRH campuses, if they meet certain conditions. Spouses also pay fees based on their individual incomes.

DoD fires Armed Forces Retirement Home boss over refusal to enact new revenue plan

Deteriorating facilities

AFRH is also facing more financial risks from costly repairs needed for deteriorating facilities, GAO auditors stated. AFRH officials noted they have received $37 million in taxpayer dollars over the last three years to tackle critical deferred maintenance projects for electrical, water, roofing, elevators, heating and air conditioning and other infrastructure. They also received $77 million in taxpayer dollars to modernize and expand units at the Washington campus principal residential Sheridan Building, and designs have been finalized for that renovation.

But previous AFRH officials had determined that a number of buildings on the AFRH Washington property were no longer useful to AFRH, and they had been included in the redevelopment plan. A majority of buildings in the development area are slated for demolition.

“AFRH, with congressional and administration support, has been working to dig out of its deferred maintenance hole to keep electricity running and water flowing on our operating assets, much less nonoperating ones, while at the same time responding to a devastating pandemic, economic disruptions, and the too-common budgetary instability of volatile capital budgets, funding lapses, continuing resolutions, and government-wide threats of across-the-board cuts,” AFRH officials stated in their response to the GAO.

“It would be a waste of resources to conduct complete assessments and preventive maintenance on structures planned for demolition.”

The way forward

AFRH has worked on proposals to improve AFRH’s financial situation without cutting services to its residents, and Congress should consider these proposals, auditors stated.

According to the GAO, Congress should consider continued infusion of taxpayer dollars, which amounted to about $25 million in 2023.

Lawmakers should also consider legislation to require the Defense Department to increase the monthly 50-cent payroll deduction from all currently-serving enlisted members, and adjust it for inflation in the future. The Defense Department has the authority under law to raise the deduction to $1 a month, but defense and service officials have not done so. The amount hasn’t changed since 1977. Enlisted members pay this each month while serving, regardless of whether they ultimately live in the homes. Adding an extra 50 cent deduction could bring in an estimated $7 million in extra revenue a year, according to GAO.

Legislation authorizing similar withholdings from National Guard and Reserve members, who in 2021 became eligible for residence at AFRH, should also be considered, according to the GAO, which could bring in an extra $7 million annually. DOD hasn’t been given authorization to withhold money from these service members for deposit into the AFRH trust fund.

Congress might also authorize the AFRH to get reimbursement from sources such as Tricare, Medicare and Medicaid for health care. Nearly all AFRH residents are eligible for Tricare, but AFRH doesn’t have the authority by law to seek reimbursement from Tricare or other federal health insurance programs. This would bring in an estimated $1 million to $4 million extra a year. AFRH provides residents with routine health care, and bears the costs of these services as an operating expense. AFRH officials said they are putting new health record systems into place that will improve health care coordination for residents, and better facilitate reimbursement for medical care provided on site.

The legislation, expected to be signed into law later this month, allows military leaders to boost the Family Separation Allowance from $250 a month to $400, the first such increase for the stipend in two decades.

Rep. Tony Gonzales, R-Texas, and a Navy veteran who was one of the sponsors of the provision, called the adjustment “much-needed relief” for families dealing with extra expenses caused by the separate living arrangements.

Under Defense Department rules, sailors who are on duty away from their home port for more than 30 continuous days are eligible for the payouts, as are troops on temporary duty away from their permanent duty station for more than 30 days.

Troops set for largest pay boost in 22 years under defense plan

However, troops who voluntarily choose to serve an unaccompanied tour of duty are not eligible for the extra payouts.

For junior enlisted service members with dependents, the extra stipend can be a much-needed boost to family finances. An E-2 with two years in service makes about $2,150 a month. An E-4 with four years service collects just under $3,000.

The authorization bill also requires a full review of the stipend as part of the Defense Department’s quadrennial review of military compensation, to ensure the payouts are adequately covering the needs of military families.

Lawmakers also included in the legislation language to study whether junior enlisted pay and military housing stipends are large enough to ensure military families are in good financial health. The bill also provides for a 5.2% increase in military base pay in 2024, the largest annual boost in 22 years.

President Joe Biden has voiced support for the authorization bill, but White House officials have not said when the measure will be officially signed into law.

On Thursday, House lawmakers voted to advance the annual defense authorization bill by a vote of 310-118. One day earlier, Senate lawmakers approved the legislation by a 87-13 vote.

The moves send the authorization bill — a massive defense policy measure which also outlines budget priorities for fiscal 2024 — to the White House for the 63rd consecutive year, a nearly unmatched level of bipartisan cooperation amid consistent political fights on Capitol Hill. Biden has already signaled that he will sign the measure.

Supporters praised the measure as a critical step in ensuring military readiness, preserving support for military families and positioning the Pentagon for future threats.

Final defense policy bill advances AUKUS, Taiwan training

“You cannot oppose this bill and claim that you support the national security of this country,” said Rep. Adam Smith, D-Wash., ranking member of the House Armed Services Committee. “Nothing is more important to the national security of this country than the people who we ask to defend it. This bill protects them.”

The $874 billion bill closely tracks with Biden’s proposed spending level for fiscal 2024, but lawmakers will still need to approve an appropriations bill next month to actually boost the money available for the Defense Department.

The measure will allow a host of policy issues, meanwhile, to move ahead in coming weeks, including a 5.2% military pay raise in 2024. The pay bump is higher than the 4.6% pay raise troops saw at the start of 2023, and the largest one-year jump in basic pay since 2002.

For an enlisted military member ranked E-4 with three years in service, the 5.2% pay raise will mean about $1,700 more next year in take-home pay compared to their 2023 paychecks. For senior enlisted and junior officers, the hike equals about $3,000 more. For an O-4 with 12 years of service, it’s more than $5,400 in extra pay in 2024.

Lawmakers also included language mandating a review of military pay rates with an eye towards “comprehensive military pay table reauthorization” in the near future.

House members last summer had pushed for targeted pay raises for junior enlisted troops to bring all military members’ annual salaries over $31,000, but that proposal was abandoned in negotiations for the final authorization bill.

But House Armed Services Committee leaders have promised to revive the issue in 2024, and will use the Pentagon’s findings to craft future pay boost legislation.

The measure also sets military end strength for fiscal 2024 at 1,284,500 troops, the lowest level since 1940. Lawmakers blamed recruiting challenges in recent years for that low target.

It also boosts special pay and incentive pay for guardsmen and reservists, ensuring those payouts are equal to what active-duty troops receive when required training and certifications are identical.

Conservative concerns

House and Senate leaders also attached to the defense bill a provision to extend part of the Foreign Intelligence Surveillance Act into mid-April, instead of allowing it to expire at the end of the year. That drew outrage from a number of conservative lawmakers who accused their leadership of caving to Democratic demands.

Lawmakers also took issue with a series of social issue provisions removed from the House-passed draft of the defense bill over the summer, including language undoing the military’s abortion access policies and rules regarding transgender medical care.

“This bill is insufficient to deal with the structural challenges that we have at the Department of Defense, where they have veered substantially left,” said Rep. Matt Gaetz, R-Fla., one of five members of the conference committee to refuse to back the final compromise.

But Republican leaders pushed back on those accusations. House Armed Services Committee Chairman Mike Rogers, R-Ala., said the final bill “goes a long way towards ending woke policies being forced on our service members” and “includes provisions that ban critical race theory and require promotions based on merit.”

Much of the language on those issues was softened from the original House draft, backed almost solely by Republican members when it passed out of the chamber. Plans to eliminate the post of chief diversity officer for the military and prohibit all future mask mandates for pandemic prevention efforts were dropped completely.

But the final bill does include provisions to ease re-enlistment rules for some troops forced out of the ranks for refusing to get the COVID-19 vaccine, and includes requirements for more communication between parents and administrators at schools run by the Defense Department.

Biden has not said when he will sign the bill into law. On Tuesday, the Office of Budget and Management praised the compromise bill, saying in a statement the agreement “provides the critical authorities we need to build the military required to deter future conflicts while supporting the servicemembers and their spouses and families who carry out that mission every day.”

Alcohol will no longer be sold at Army & Air Force Exchange Service outlets between the hours of 10 p.m. and 6 a.m. Shop hours vary by base and type of store.

The change will affect 161 shops worldwide, including Express stores, Class Six stores and main exchange stores. Those that sell booze overnight comprise about a quarter of AAFES stores that offer packaged alcohol and spirits, AAFES spokeswoman Marisa Conner said in an email.

Feedback about the decision has been “nominal,” Conner said. Alcohol sales between 10 p.m. and 6 a.m. at those 161 stores accounted for less than 1% of total alcohol sales last year, she said.

The move aligns Army and Air Force stores with the policies of other military exchange systems, Conner said.

Navy and Marine Corps exchanges stopped selling alcohol in any of their exchange outlets after 10 p.m. in 2013. Navy policy allows sales of alcohol in exchange outlets from 6 a.m. to 10 p.m., while Marine Corps exchanges sell it from 8 a.m. to 10 p.m. A limited number of military commissaries sell beer and wine, but commissaries are typically not open late.

The decision also follows the recommendations of a February report by the Department of Defense’s Suicide Prevention and Response Independent Review Committee.

The panel cited research that suggests that limiting when alcohol can be sold reduces heavy drinking and other adverse outcomes associated with alcohol misuse. Cutting those hours may also offer a strategy for reducing overall alcohol consumption, especially among younger personnel who live in military housing, the committee reported.

Nearly 500 troops died by suicide in 2022, according to the Pentagon’s latest annual suicide report released in October. While fewer people died, the active duty suicide rate rose by 3%, data showed.

Eighteen percent of service members who died by suicide had been diagnosed with an alcohol use disorder, the Pentagon found in 2021. The committee also cited research showing that, of suicides in the American public where toxicology data was available, about 1 in 3 people were acutely intoxicated at their death.

Some other recommendations by the committee included banning the promotion of alcohol on Defense Department property; increasing the price of alcohol; and funding safe transportation programs for service members living on base.

Some online commenters have speculated that the ban of overnight sales of alcohol might result in other problems.

“Now instead of walking five minutes to the shopette for a beer run, Joe is gonna hop in his V6 Camaro and drive to the liquor store off post and get a DUI,” Reddit user BabyBackFriedFish wrote Nov. 30.

The Combating Auto Retail Scams Rule, or CARS Rule, “is expected to save consumers nationwide more than $3.4 billion and an estimated 72 million hours each year shopping for vehicles,” according to a Dec. 12 announcement by the FTC. The new 372-page rule goes into effect on July 30, 2024.

The new CARS Rule will take a harder stance on prohibiting price misrepresentations, among other key information. Of interest to the military community is the prohibition against lying about whether dealers are affiliated with the military or any government entity.

Dealers are also prohibited from lying about whether a vehicle can be moved out of state or out of the country, a particular concern to military families who relocate frequently. Those with car loans may be affected, however, because in many cases lenders won’t allow a vehicle to be moved overseas, and there’s no law against that.

But for leased vehicles, under certain circumstances, the Servicemembers Civil Relief Act allows active duty troops to terminate their lease without having to pay penalties or early termination charges.

The CARS Rule, which applies to all motor vehicle dealers, focuses on two common types of illegal tactics used when buying or leasing vehicles: bait-and-switch advertising and hidden junk fees. For military consumers, such auto-related gripes are among the top 10 complaints the FTC receives.

“As a small business owner and active duty military member I have played the role of both a buyer, toiling for hours to just reach fair deals on vehicles, as well as that of an advocate for my sailors who have been preyed upon by local dealerships,” one sailor wrote to the FTC during the rulemaking process. “Nowhere else in our society do so many average citizens have to mentally prepare for a battle over fair pricing and treatment for something that is realistically a modern necessity.”

Over the years, a number of issues have emerged with car dealerships outside military bases, resulting in some commanders restricting troops’ access to certain businesses.

The FTC noted that service members, particularly young troops, have an average of twice as much auto debt as civilians. By age 24, about 20% of young troops have at least $20,000 in auto debt, which is nearly two-thirds of an enlisted service member’s base salary at that age, according to the rule, which cited information from a 2022 report from the Consumer Financial Protection Bureau.

Some of the other provisions designed to help all consumers include:

• Requiring dealers to get consumers’ specific consent for add-ons and other charges
• Requiring accurate price disclosures in dealers’ advertising and sales communications
• Prohibiting the sale of any add-on product or service that doesn’t provide any benefit to the consumer

Consumers have also complained to the FTC about driving hours to dealerships based on advertised prices, spending hours in the process of choosing and test-driving a vehicle, and negotiating the price and financing terms.

These processes, according to many complaints, are often made worse when dealers add-on products or packages they claim are required to purchase or finance the vehicle — even though such items were not included in the low prices advertised.

Some members of the industry commented that many of the areas covered by the proposed rule were already addressed in industry guidance. The FTC responded that “although industry guidance can provide helpful information to dealers, dealers who choose not to follow such guidance, or engage in deceptive or unfair practices, subject their customers to significant harm,” according to the rule.

“When dealerships advertise prices, discounts, or other terms that are not actually available to typical consumers, consumers who select that dealership instead of others spend time visiting the dealership or otherwise interacting with the dealership under false pretenses,” the document added.

From July 2022 to September 2022, the FTC received more than 27,000 comments about the proposed rule from various individuals and entities, ranging from car dealers to consumers.

Violation of the CARS Rule could result in actions that require a company to change its business practices, give money back to injured consumers, and pay civil penalties of as much as $50,120 per violation.