Updated December 16, 2020
Defense Primer: Exceptional Family Member Program (EFMP)
Congress appropriates funds for servicemember and family
Eligibility and Enrollment
benefits, including services to improve quality of life or
DOD Instruction 1315.19 requires active duty
attenuate challenges. Military families face frequent moves
servicemembers to enroll in EFMP if they have a dependent
around the globe, often causing disruptions to spousal
with a qualifying special need. Members of the Reserve
employment, school or child care arrangements, and other
Component are not required to enroll in EFMP, unless they
challenges associated with establishing a household in a
are in an active duty status (>30 consecutive days). DOD
new location.
civil service employees selected for overseas assignments
are eligible for EFMP services on a space-available basis.
Military members who have a dependent (spouse, child, or
dependent parent) with special needs may experience
Servicemembers may receive guidance on eligibility and
significant stress during these moves due to the need to find
completing enrollment in the program at their installation
specialized health care providers, school systems with
EFMP office. EFMP enrollment is not portable and
dedicated support services, and community support
servicemembers must register for the program when
assistance. The military established the Exceptional Family
transferring to a new duty station. While there are no costs
Member Program (EFMP) to ease these additional burdens
to enroll in the program, certain costs may be associated
of a move for such families.
with medical documentation required for enrollment. These
Background
costs may be reimbursed by the member’s service or
through DOD’s health benefits program, TRICARE.
The U.S. Army started EFMP in 1979, with the other
services following. Enrollment was voluntary and the
Criteria for EMFP Enrollment
program initially provided medical support to families with
(one or more of the following)
special needs in the United States and overseas locations.
Life-Threatening or Chronic Condition Requiring Special
As child advocacy groups raised concerns over the unique
Care (e.g., fol ow-up from a primary care manager)
pressures of military service on families, Congress enacted
the Military Family Act of 1985 as part of the Department
Current and Chronic Mental Health Condition
of Defense Authorization Act, 1986 (P.L. 99-145 §§801-
Asthma or Other Respiratory-Related Diagnosis
813). This act directed the Department of Defense (DOD)
Attention Deficit Disorder/Attention Deficit
to create an Office of Family Policy to “coordinate
Hyperactivity Disorder
programs and activities of the military departments as they
relate to military families.”
Chronic Condition Requiring Adaptive Equipment,
Assistive Technologies, or Environmental/Architectural
After 20 years of high operational tempo and congressional
Considerations
hearings on strength, vitality, and sustainability of military
Special Educational Needs
family support programs, Congress created the Office of
Community Support for Military Families with Special
EFMP Services and Support
Needs in Section 563 of the National Defense Authorization
EFMP offices also assist with the coordination of military
Act (NDAA) for FY2010 (P.L. 111-84). Later renamed the
assignments and family support services. Dependents are
Office of Special Needs (OSN), its statutory mission is to
eligible for support services once the servicemember has
develop DOD-level oversight of EFMP and “enhance and
enrolled in the program.
improve DOD support around the world for military
families with special needs (whether medical or educational
EFMP offices validate educational and medical resource
needs).”
availability at the servicemember’s projected duty location,
in partnership with the services’ personnel organizations. If
OSN establishes DOD policy to support military families
specific services or resources are not available at the
with special needs, while each service (Army, Navy,
servicemember’s prospective duty location, their military
Marine Corps, and Air Force) is responsible for
orders may be canceled or modified.
administering its own EFMP. While the degree of legal,
EFMP’s family support services identify local programs
educational, and training assistance provided varies by
service, OSN coordinates with each service, the Defense
and resources to support individual needs. This includes
Health Agency (DHA), and the DOD Education Activity in
connecting dependents with community support groups,
an effort to ensure EFMP adequately supports military
Individuals with Disabilities Education Act (P.L. 101-476)
families. OSN holds quarterly advisory panels with military
early intervention programs, and special education services.
families to assess program satisfaction and provides an
EFMP enrollees may also receive respite care. Eligibility,
annual report to Congress (10 U.S.C. §1781c(g)).
availability, and amount of monthly-allotted respite care
hours varies by service.
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Defense Primer: Exceptional Family Member Program (EFMP)
Variance in Services and Support to Dependents
EFMP Services and Support
In addition to the aforementioned variances in respite care,
Information and Referral for
military service organizations and certain EFMP enrollees
Education and Outreach to
Military and Community
have observed differences in certain legal services,
EFMP Families
Services
development of service plans, training opportunities,
relocation services, program staffing levels, and frequency
Refer Families with Serious
Provide Local School and
of contact with EFMP offices. The complexity of this
Complicated Medical Issues
Early Intervention Services
situation may grow for military families at a joint base,
to the Military Health System
Information
where a service different from the family leads the local
Col aboration with Military,
EFMP office and observes different standards.
Provide Assistance Before,
Federal, State, and Local
EFMP Support to the Reserve Component
During, and After a
Agencies on Special Program
Relocation
By regulation (32 C.F.R. §75.4), EFMP is only available to
Development
eligible active duty servicemembers and their dependents.
Develop and Maintain
Non-Clinical Case
Members of the Selected Reserve (i.e., drilling reservists),
are not eligible for EFMP services. Reservists could benefit
Individual Service Plans
Management
from these services, particularly when serving on short-term
EFMP enrollees may also be eligible to enroll in the
active or inactive training duty periods (<30 consecutive
days). Extending EFMP eligibility to drilling reservists
TRICARE Extended Care Health Option (ECHO) program,
could also create additional complexities in coordinating
which pays for additional services and supplies for those
with special needs. As of October 2018, approximately 8%
DOD, state, or community-based family support and add to
the program’s
(137,000) of military dependents received support from
cost.
EFMP (see Figure 1). Army dependents were the largest
Medical Coordination for EMFP Enrollees
share (40%) of those receiving EFMP support.
The FY2017 NDAA (P.L. 114-328 §702) directed
Figure 1. EFMP-Enrolled Dependents, 2012-2018*
numerous Military Health System (MHS) reforms,
including the transfer of administration of all military
hospitals and clinics from the services to the DHA. Each
service is to continue administering its own EFMP and
retain some medical responsibilities, such as screening and
developing support plans. DHA is to be responsible for
providing required medical support for EMFP enrollees,
instead of the services (as was previously done). While
Congress directed MHS reforms designed to streamline the
delivery of health care, the new MHS organizational
structure could impede or delay EMFP enrollee access to,
or coordination of, complex medical services.
Relevant Statutes, Regulations, and Policies
Source: Communication from DOD Officials, 2018.
Notes: *data as of October 2018. The Department of the Air Force
10 U.S.C. §1781c – Office of Special Needs
was unable to provide data for 2013, 2015, and 2017.
32 C.F.R. Part 75 – Exceptional Family Member Program
Current Challenges
DOD Instruction 1315.19 – The Exceptional Family Member
Congress may consider legislation to address selected
Program (EFMP)
issues identified by the Government Accountability Office
CRS Products
(GAO), DOD, and advocates of families with special needs.
CRS Report R43631, The Individuals with Disabilities Education
Absence of Program Standardization
Act (IDEA), Part C: Early Intervention for Infants and Toddlers with
In 2012 and 2018, GAO found that EFMP implementation
Disabilities, by Kyrie E. Dragoo
“var[ies] widely for each branch of Military Service,” and
CRS In Focus IF11002, Defense Health Primer: TRICARE
that the overall program lacks standardization. GAO
Extended Care Health Option (ECHO), by Bryce H. P. Mendez
recommended that DOD 1) assess and report to Congress
Other Resources
how each service provides support to its members; 2)
develop a common set of performance metrics; and 3)
Government Accountability Office, GAO Report 18-348,
evaluate the monitoring activities of each service.
Military Personnel: DoD Should Improve Its Oversight of the
Concurring with these recommendations, DOD is in the
Exceptional Family Member Program, May 8, 2018
planning stages to address them. As of December 2020,
Government Accountability Office, GAO Report 12-680,
GAO’s recommendations remain open for DOD action.
Better Oversight Needed to Improve Services for Children with
Special Needs, September 10, 2012
An October 2018 RAND study on Enhancing Family
Stability During a Permanent Change of Station (PCS)
RAND, RR2304, Enhancing Family Stability During a Permanent
found that the “needs related to having a family member
Change of Station, October 2018
[in] EFMP [was] the most frequently mentioned negative
aspect of PCS moves…” and that “the specific provisions
Bryce H. P. Mendez, Analyst in Defense Health Care
vary across service branches.”
Policy
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Defense Primer: Exceptional Family Member Program (EFMP)
IF11049
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