The MHS Modified Payment and Waiver Program is a new program to prevent financial harm to civilian non-beneficiaries who received care at a military hospital or clinic on or after June 21, 2023.

Although most of the care provided to civilians is emergency care, other typical circumstances for civilian treatment at military hospitals and clinics include space-available care in certain specialties, and specific agreements with local communities. Care isn't limited to ambulance arrivals.

Military hospitals and clinics provide care to civilians for medical readiness reasons and only when space and capability exist without adversely impacting our beneficiary population. Rendering care enhances the skills of military health care providers.

Not all military hospitals and clinics provide emergency care to civilians. Capabilities vary based on facility size, location, and mission.

More than 20,000 civilians are treated annually at military hospitals and clinics for emergency and trauma care. Federal civilian employees—particularly at overseas military installations, are also provided care at MTFs on a space available basis.

Civilians who aren't beneficiaries of the MHS are generally charged for treatment received at military hospitals and clinics. Billing processes are similar to those at private sector civilian hospitals. For patients with insurance, the facility will submit a claim to the individual’s health insurer. If the patient’s Explanation of Benefits indicates that the patient is responsible for any portion of the bill, the facility will submit an invoice to the patient. For uninsured patients, the facility will mail a medical bill to the patient.

Patients may apply to the MHS Modified Payment and Waiver Program if they require financial relief. This includes:

• Insured patients who need assistance paying their portion of the bill (post-insurance payment)
• Uninsured patients
• Federal employees who receive care at military hospitals and clinics

Civilians without insurance or who are unable to pay may apply to the MHS Modified Payment and Waiver Program if their care occurred on or after June 21, 2023. In some cases, under the program a bill may be reduced to zero or substantially discounted based on the patient’s income, or it may be waived if the DHA Director determines that the provision of care enhanced the knowledge, skills, and abilities of military health care providers.

For care received prior to that date, patients can work with the DHA Debt Adjudication Office or the Department of the Treasury's Cross-Servicing Program to discuss other available options for financial relief.

While specific collection rate percentages are not publicly released, the Federal Claims Collection Standards mandate that federal agencies aggressively collect all debts. The very creation of the MHS Modified Payment and Waiver Program by Congress was in response to the "substantial medical bills" and "financial harm" this aggressive collection caused for some civilian patients. This program is designed to create a more compassionate and successful resolution process.

The Defense Health Agency has 606 clinics and 45 hospitals worldwide*. Over 40 provide emergency services.

Source: Fiscal Year 2024 TRICARE Program Evaluation Report 

A trauma center designation is a classification system for hospitals based on their ability to provide comprehensive emergency care for severely injured patients. There are five levels. Level I is the highest.

The DHA has 14 designated trauma centers. These centers have specialized staff, resources, and protocols to provide immediate, comprehensive care. Studies have shown these resources can significantly improve survival rates for severely injured patients.

This question addresses two fundamentally different situations. TRICARE is a health insurance benefit with established premiums and cost-shares that beneficiaries are aware of.

The MHS Modified Payment and Waiver Program, is a financial hardship safety net for civilian non-beneficiaries who aren't part of the TRICARE system and are often billed the full, unsubsidized cost of care, which can be financially catastrophic. The program's stratified fees were specifically designed to be equitable with what military retirees pay for comparable services in the private sector.

No. Military hospitals and clinics aren't open to the general public for routine care, nor is the health care free. Individuals will be billed by the medical facility. The care provided to civilians occurs under specific, pre-existing legal authorities, primarily for life-threatening emergencies or when it directly supports the readiness training of our medical personnel.

This program doesn't change who's treated. This program only provides a mechanism for financial relief after care has already been provided.

The care provided to our TRICARE beneficiaries is and will remain our top priority. TRICARE funding isn't affected by this program. This program doesn't represent a new cost or expenditure, but rather a change in how we handle uncollected revenue.

Congress has determined that the readiness value of providing this care, combined with the public good of preventing catastrophic financial harm, outweighs the monetary value of pursuing debts from individuals who can't pay. This program aligns our billing practices with that congressional mandate.