Defense Primer: Exceptional Family Member Program (EFMP)

Defense Primer: Exceptional Family Member Program (EFMP)

Updated November 14, 2022
Defense Primer: Exceptional Family Member Program (EFMP)
Congress authorizes programs and appropriated funds for
with a qualifying special need. Members of the Reserve
servicemember and family benefits, including services to
Component are not required to enroll in EFMP, unless they
improve quality of life or attenuate military-specific
are in an active duty status (for more than 30 consecutive
challenges. Military families face frequent moves around
days). DOD civil service employees selected for overseas
the globe, often causing disruptions to spousal employment,
assignments are eligible for EFMP services on a space-
school or child care arrangements, and other challenges
available basis.
associated with establishing a household in a new location.
These challenges are often compounded for families with
Criteria for EMFP Enrollment
special needs.
(one or more of the following)
Military members who have a dependent (spouse, child, or

Life-threatening or chronic condition requiring special
dependent parent) with special needs may experience
care (e.g., follow-up from a primary care manager)
significant stress during these moves due to the need to find

Current and chronic mental health condition
specialized health care providers, school systems with

Asthma or other respiratory-related diagnosis
dedicated support services, and community support

assistance. The military established the Exceptional Family

Attention deficit disorder/Attention deficit hyperactivity
Member Program (EFMP) to ease these additional burdens
disorder
of a move for such families.

Chronic condition requiring adaptive equipment, assistive
Background
technologies, or environmental/architectural
considerations
The U.S. Army started EFMP in 1979, with the other

services following. Enrollment was voluntary and the

Special educational needs
program initially provided medical support to families with
Servicemembers may receive guidance on eligibility and
special needs in the United States and overseas locations.
completing enrollment in the program at their installation
As child advocacy groups raised concerns over the unique
EFMP office. When transferring to a new duty station,
pressures of military service on families, Congress enacted
EFMP enrollment is portable; though additional paperwork
the Military Family Act of 1985 as part of the Department
may be required in order to coordinate and continue certain
of Defense Authorization Act, 1986 (P.L. 99-145 §§801-
services and support. There are no costs to enroll in the
813). This act directed the Department of Defense (DOD)
program. However, there may be costs associated with
to create an Office of Family Policy to “coordinate
obtaining civilian medical documentation required for
programs and activities of the military departments as they
enrollment that may be reimbursed by the member’s service
relate to military families.”
or through DOD’s health benefits program, TRICARE.
Congress later created the Office of Community Support for
EFMP Services and Support
Military Families with Special Needs in Section 563 of the
EFMP offices also assist with the coordination of military
National Defense Authorization Act (NDAA) for FY2010
assignments and family support services. Dependents are
(P.L. 111-84). Renamed the Office of Special Needs (OSN)
eligible for support services once the servicemember has
in 2016, its statutory mission is to develop DOD-level
enrolled in the program.
oversight of EFMP and “standardize, enhance, and improve
DOD support around the world for military families with
EFMP Services and Support
special needs (whether medical or educational needs).”
Information and referral for
OSN establishes DOD policy to support military families
Education and outreach to
military and community
with special needs, while each military service is
EFMP families
Services
responsible for administering its own EFMP. The degree of
legal, educational, and training assistance provided varies
Refer families with serious
Provide local school and early
by service. OSN coordinates with the services, Defense
complicated medical issues to
intervention services
Health Agency (DHA), and DOD Education Activity in an
the Military Health System
information
effort to ensure EFMP adequately supports military
Collaboration with military,
families. OSN holds quarterly advisory panels with military
Provide assistance before,
federal, state, and local
families to assess program satisfaction and is required to
during, and after a relocation
agencies on special program
provide an annual report to Congress (10 U.S.C.
development
§1781c(g)).
Eligibility and Enrollment
Develop and maintain
Non-clinical case
individual service plans
management
DOD Instruction 1315.19 requires active duty
servicemembers to enroll in EFMP if they have a dependent

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Defense Primer: Exceptional Family Member Program (EFMP)
Figure 1. EFMP-enrolled Dependents, 2014-2020

Source: Email communication with DOD and USCG officials, February 2021.
Notes: The Department of the Air Force was unable to provide data for 2015. Air Force data for 2020 includes Space Force enrollees.
EFMP offices validate educational and medical resource
Medical Coordination for EMFP Enrollees
availability at the servicemember’s projected duty location,
The FY2017 NDAA (P.L. 114-328 §702) directed
in partnership with the services’ personnel organizations. If
numerous Military Health System (MHS) reforms,
specific services or resources are not available at the
including the transfer of administration of all military
servicemember’s prospective duty location, their military
hospitals and clinics from the Services to the DHA. Each
orders may be canceled or modified.
service is to continue administering its own EFMP and
EFMP’s family support services identify local programs
retain some medical responsibilities, such as screening and
developing support plans. In general, DHA is responsible
and resources to support individual needs. This includes
for providing required medical support for EMFP enrollees,
connecting dependents with community support groups,
instead of the Services (as was previously done). While
Individuals with Disabilities Education Act (P.L. 101-476)
Congress directed MHS reforms designed to streamline the
early intervention programs, and special education services.
delivery of health care, the reformed MHS organizational
EFMP enrollees may also receive respite care. Eligibility,
structure could impede or delay EMFP enrollee access to,
availability, and amount of monthly allotted respite care
or coordination of, complex medical services.
hours varies by service. EFMP enrollees may also be
eligible to enroll in the TRICARE Extended Care Health
Relevant Statutes, Regulations, and Policies
Option (ECHO) program, which pays for additional
10 U.S.C. §1781c – Office of Special Needs
services and supplies for those with special needs. In 2020,
32 C.F.R. Part 75 – Exceptional Family Member Program
9% (146,824) of military dependents received support from
EFMP (see Figure 1).
DOD Instruction 1315.19 – The Exceptional Family Member
Current Challenges
Program (EFMP)
Congress may consider legislation to address selected
CRS Products
issues identified by the Government Accountability Office
CRS In Focus IF11002, Defense Health Primer: TRICARE Extended
(GAO), DOD, and advocates of families with special needs.
Care Health Option (ECHO), by Bryce H. P. Mendez
Absence of Program Standardization and
CRS Report R43631, The Individuals with Disabilities Education Act
Inconsistency of Services to Dependents
(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
Other Resources
that the overall program lacks standardization. GAO
GAO Report 20-400T, Military Personnel: DoD Has Made Limited
recommended that DOD (1) assess and report to Congress
Progress toward Improving Oversight of the Exceptional Family
how each service provides support to its members; (2)
Member Program, February 5, 2020
develop a common set of performance metrics; and (3)
GAO Report 18-348, Military Personnel: DoD Should Improve Its
evaluate the monitoring activities of each service. As of
Oversight of the Exceptional Family Member Program, May 8, 2018
November 1, 2021, GAO’s recommendations remain open
for DOD action. A 2021 RAND study identified similar
GAO Report 12-680, Better Oversight Needed to Improve Services
findings and recommended policy updates to improve
for Children with Special Needs, September 10, 2012
“consistency across services where possible” and to
RAND, RR-A742-1, The Exceptional Family Member Program, 2021
“standardize the experience that military families have with

the EFMP.”
Bryce H. P. Mendez, Analyst in Defense Health Care
Policy
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Defense Primer: Exceptional Family Member Program (EFMP)

IF11049

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