Defense Health Primer: U.S. Coast Guard Health Services

Defense Health Primer: U.S. Coast Guard Health Services

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Updated October 25, 2023
Defense Health Primer: U.S. Coast Guard Health Services
Established in 1790, the U.S. Coast Guard (USCG) is a
These funds are separate from DOD’s Defense Health
military service in the Department of Homeland Security
Program account that funds the MHS.
(DHS) and a branch of the armed forces of the United
States. The role of USCG is to provide security, maritime
USCG Health Services Personnel
safety, and environmental stewardship on the high seas and
A variety of medical professionals staff the USCG Health
in the ports, inland waterways, and maritime economic
Services program, including physicians, dentists, advanced
zones of the United States. To support these tasks, 14
practice providers, nurses, corpsmen, and administrators. At
U.S.C. §504 authorizes USCG to administer a Health
the end of FY2023, 1,343 personnel were assigned to the
Services program to sustain the medical readiness of
USCG Health Services program. This included a mix of
approximately 50,000 active duty and reserve
USCG officers and enlisted servicemembers (67%),
servicemembers of the Coast Guard. The USCG program
USPHS officers (14%), civil servants (5%), and contractors
also collaborates with the Military Health System (MHS) of
(14%).
the Department of Defense (DOD) to offer health care
USPHS Support to USCG
services to 9.6 million beneficiaries eligible for the
USPHS has historically provided health care support to
TRICARE program.
USCG, originally through its now-decommissioned Marine
Mission
Hospital Service. By law (42 U.S.C. §253), USCG is
The USCG Health, Safety, and Work-Life (HSWL)
entitled to USPHS support for “medical, surgical, and
Directorate (CG-11) administers the USCG Health Services
dental treatment and hospitalization.” A 2019
program; it
Memorandum of Understanding (MOU) formalizes this
•
medical support relationship, which assigns USPHS
provides health care to active duty and reserve
officers to fill certain USCG personnel requirements on a
servicemembers supporting USCG missions;
•
reimbursable-basis. USPHS officers may be assigned to a
“ensure[s] the medical and dental readiness” of
servicemembers for “world
clinic or a ship and can deploy with certain USCG units.
-wide deployment;” and
• ensures the availability of quality, cost-effective health
USCG Health Services
care for all eligible Coast Guard beneficiaries (i.e.,
USCG offers a limited range of outpatient medical and
active and reserve servicemembers, retirees, and family
dental care (e.g., primary care; occupational health; flight
members).
medicine; optometry; mental health; physical therapy;
Organization
dentistry; and basic laboratory, radiology, and pharmacy
services). USCG delivers these health care services in fixed
The CG-11 Director is typically a U.S. Public Health
U.S. health care facilities, ships, and certain deployed
Service (USPHS) flag officer (O-8) assigned to USCG
environments. USCG operates 44 shore-based outpatient
Headquarters and serves as the chief medical advisor (i.e.,
clinics in the United States (see Figure 1) and no inpatient
Surgeon General) to the USCG Commandant. The CG-11
facilities. The clinics function similarly to DOD’s military
Director also works under the immediate supervision of the
treatment facilities (MTFs).
Assistant Commandant for Human Resources, who reports
to the Deputy Commandant for Mission Support.
Figure 1. USCG Shore-Based Clinics
The CG-11 Director delegates day-to-day oversight and
administration of the program to the Chief of Health
Services, who also functions as the Deputy Surgeon
General of the Coast Guard. The HSWL Service Center
administers the various health programs under its purview,
which include 14 Regional Practice offices that provide
technical assistance and administrative oversight for all
USCG clinics and shipboard medical assets.
Budget
Most USCG health-related spending is organized into
several Program, Project, and Activity categories of the
Coast Guard’s Operations and Support account in the

annual DHS appropriation. The fiscal year (FY) 2024
Source: CRS graphic based on data provided by USCG officials,
USCG budget request included $1.2 billion in discretionary
August 2020.
funds for health-related spending and $250.5 million in
Note: USCG clinics in Guam and Puerto Rico are not depicted on
mandatory funds that pay for USCG retiree health care.
this map.
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Defense Health Primer: U.S. Coast Guard Health Services
Additionally, most USCG ships are equipped with a sickbay
clinics and units. In 2022, the Government Accountability
staffed with at least one health care provider. Shipboard
Office (GAO) found that USCG “cannot ensure it has the
health services are generally limited to primary care and
right number and type of medical and dental staff to keep
first-responder care; however, some ships may be equipped
its personnel ready to meet its mission.” Section 11406 of
and staffed to conduct certain emergency surgical
FY2023 NDAA directed USCG to develop medical staffing
procedures. Typically, when a patient’s medical needs
standards that take into consideration current and future
exceed the medical capabilities of a USCG clinic or
DHS missions, requirements for certain clinical specialties,
sickbay, they can be referred or medically evacuated to a
workforce mix (uniformed, civilian, and contract
DOD MTF or civilian medical facility participating in
personnel), and staffing at remote USCG clinics. The
TRICARE. Approximately 60% of all active duty USCG
provision required USCG to have developed these
servicemembers obtain their health care primarily at a
standards by June 2023 and to provide a report to Congress
USCG clinic, while others (including Coast Guard retirees
not later than 180 days after developing the standards.
and family members) receive their health care at a DOD
Disability Evaluation System
MTF or TRICARE provider.
USCG utilizes a legacy Disability Evaluation System
Interaction with TRICARE
(DES) process to evaluate a servicemember’s fitness for
Chapter 55 of Title 10, U.S. Code, entitles all active duty
duty and make a determination on retention or separation
members, retirees, and family members of the uniformed
from military service. In comparison, DOD used to use a
services (including USCG) to the benefits offered by the
similar legacy DES process that GAO found to have long
TRICARE program, including care in DOD MTFs. Statute
delays, duplicate DOD and VA processes, and confuse
(14 U.S.C. §506) requires DHS to reimburse DOD for MTF
servicemembers. DOD transitioned to a more streamlined
care provided to Coast Guard beneficiaries. Non-USCG
process called the Integrated Disability Evaluation System
beneficiaries may receive primary care in USCG clinics
(IDES) in 2012, while USCG continues to primarily use a
under certain conditions established by the HSWL Service
legacy DES process. In March 2020, USCG began a five-
Center and on a space-available basis. In general, USCG
site pilot program to replace its legacy DES with IDES.
health services policies on quality and access to care mirror
USCG has not yet announced plans to implement IDES
or defer to DOD’s policies.
across all installations.
Current Challenges
Section 11243 of the FY2023 NDAA required GAO to
There are a number of perceived challenges facing the
conduct a study and provide a report to Congress on
USCG Health Services program, many of which have
USCG’s DES and make recommendations to improve the
attracted congressional attention and ongoing oversight.
overall process. The law also required USCG to develop a
USCG Health Services Strategy
temporary, then permanent policy that improves the
“timeliness, communication, and outcomes” and affords
Since at least 2021, Congress has expressed interest in
maximum career and separation transition benefits for
understanding the current state of USCG Health Services
and how the service’s
servicemembers going through the DES process.
medical capabilities are used to
support operations and medical readiness of the force. In
Relevant Statutes, Regulations, and Policies
2022, the USCG Commandant published the service’s
strategy, which includes actions to “generate a modern and
Chapter 55, Title 10, U.S. Code
ready workforce” through the delivery of “point-of-need
Sections 504 and 948, Title 14, U.S. Code
healthcare.” These actions include modernization of health
Section 253, Title 42, U.S. Code
service policies and procedures, development and
Part 199, Title 32, Code of Federal Regulations
diversification of technologies to deliver high-quality health
care, and strengthening “organic Coast Guard medical
Part 31, Title 42, Code of Federal Regulations
capability” through innovation and workforce training
USCG Commandant Instruction M6000.1F, Coast Guard
initiatives.
Medical Manual, June 2018
Congress enacted several provisions in the Don Young
USCG Commandant Instruction M1850.2D, Physical Disability
Coast Guard Authorization Act of 2022, as part of the
Evaluation System, May 19, 2006
James M. Inhofe National Defense Authorization Act for
CRS Products
2023 (FY2023 NDAA; P.L. 117-263), to require review,
CRS In Focus IF10530, Defense Primer: Military Health System,
study, or implementation of certain health services-related
by Bryce H. P. Mendez
reforms. Section 11407 of the FY2023 NDAA directed the
USCG Commandant to conduct a “comprehensive review”
Other Resources
and develop a strategic plan that improves and modernizes
GAO, Coast Guard Health Care: Improvements Needed for
the health services program “to ensure access to high-
Determining Staffing Needs and Monitoring Access to Care, GAO-
quality, timely healthcare” for USCG beneficiaries. The
22-105152, February 2022
provision requires a report to Congress on the review’s
findings and recommendations, strategic plan, and a
GAO, Coast Guard Health Care: Additional Actions Could Help
description of how the Commandant would implement the
Ensure Beneficiaries’ Access, GAO-23-105574, April 2023
recommendations.

USCG Health Services Staffing Needs
Bryce H. P. Mendez, Specialist in Defense Health Care
USCG has typically based its health services staffing
requirements on “historical staffing levels” at individual
Policy
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Defense Health Primer: U.S. Coast Guard Health Services

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