In a notice expected in the Federal Register on Thursday, the Defense Department will launch a three-year pilot in September that will reimburse eligible troops to preserve their gametes before deployment.

The benefit, required under the fiscal 2025 National Defense Authorization Act, will pay service members up to $500 per year for sperm retrieval and cryopreservation and $10,000 per year for egg preservation services.

Those eligible include active-duty DoD personnel who receive orders qualifying for hazardous duty pay, those who expect to get such orders within 120 days and those geographically separated from a “spouse, domestic partner or dating partner” for 180 days or more.

Military families and family planning advocates have lobbied for more than a decade to increase access to fertility services, to include cryopreservation of sperm and egg cells before combat deployments, in vitro fertilization and other advanced reproduction treatments.

In 2014, the Bob Woodruff Foundation sponsored a one-of-a-kind, two-day conference on intimacy and family issues among the combat injured that highlighted the need among wounded personnel to have broader access to family planning counseling, gamete banking and fertility treatments.

Nearly 2,000 troops received debilitating injuries to their groins or genital regions between 2000 and 2013, and 307,000 service members experienced some type of head injury during the same time frame — injuries that sometimes can affect fertility and sex drive.

In 2016, then Defense Secretary Ash Carter announced that the Pentagon would begin covering sperm and egg freezing for service members, but the planned pilot never came to fruition following the election later that year of President Donald Trump.

Military families have often spent their own money on cryopreservation as a safeguard, and in extreme cases, have paid to extract sperm from dying loved ones to ensure the possibility of advanced reproductive services.

In 2019, the parents of West Point Cadet Peter Zhu extracted their son’s sperm after he was fatally injured in a skiing accident. They argued in court that Zhu had expressed wanting to have a family someday, and they wanted to preserve his sperm to provide future options.

In Israel, since the start of the Gaza conflict, the military has started offering the option to retrieve the sperm of deceased service members when delivering casualty notifications, according to The New York Times.

Since at least 2022, organizations such as the Military Family Building Coalition, Resolve: The National Infertility Association and others have provided free cryopreservation services to some service members, but until now, no government assistance has been available for deploying troops.

How the program works

Under the pilot, service members can elect to obtain preservation services at a military treatment facility that offers reproductive programs or through a civilian clinic of their choice.

Commanders must validate eligibility, as the Defense Health Agency does not have access to orders. To receive reimbursement, eligible troops must have written affirmation from their commands.

Reimbursement must be requested within 120 days after covered services began — usually the date of retrieval, prescription or lab procedure. Troops must submit itemized invoices and DHA Form 459.

Service members could be eligible for the program more than once within the three-year pilot. Any decisions regarding continued storage, disposition or later use following participation “are solely the responsibility of the covered member and outside the scope of the program,” according to the announcement.

Throughout the pilot, the DoD plans to study the program’s popularity, its cost, continued feasibility and impact on readiness, according to the announcement.

More information on the benefit will be available in the Aug. 13 edition of the Federal Register.

Sen. Elizabeth Warren, D-Mass., raised concerns about anti-competitive tactics, questioning the practice of allowing Express Scripts — the largest pharmacy benefit manager in the United States — to have the contract as exclusive administrator of the Tricare pharmacy program, while owning and operating two mail-order pharmacies, Express Scripts Pharmacy and Accredo Specialty Pharmacy.

She questioned whether Express Scripts drives more business to itself, pushing local pharmacies out of the Tricare network and limiting beneficiaries’ access to more personalized local care.

“That is a clear conflict of interest,” Warren said during a hearing of the Senate Armed Services’ personnel subcommittee. It’s “an open invitation for Express Scripts to milk the federal government, kick out competitors, and steer big bucks to itself.”

Warren, ranking member of that subcommittee, said DoD requires the Tricare pharmacy contractor to own both a pharmacy benefit manager and a pharmacy.

The contractor, Express Scripts, receives a fixed administrative fee per prescription filled at retail pharmacies or the mail order pharmacy, said Dr. David J. Smith, a retired Navy rear admiral who is deputy director of the Defense Health Agency. The contractor can’t generate revenue from the prices of drugs, he said, and the DoD model eliminates common commercial industry profit mechanisms.

Under the mail-order program, the government buys the drugs, and Express Scripts dispenses the drugs and are paid that administrative fee. The amount of that fee, or other information about the contract, is not public knowledge, as DoD and Express Scripts consider it proprietary information.

Beneficiaries pay $14 per prescription filled through the mail order pharmacy and $16 at network retail pharmacies. That money isn’t kept by Express Scripts; it goes to the Defense Health Agency, said Adam Kautzner, president of Express Scripts and Evernorth Care Management. Beneficiaries can get their prescriptions filled at military treatment facilities at no charge.

In general, DoD has been trying to move to mail order because it’s cheaper, Smith said, and because of the convenience for beneficiaries.

DoD continues to find ways to deliver the benefit to make sure beneficiaries have access to their medication, in a “fiscally responsible way,” he said, adding that they’re also working on ways to shore up the supply chain for medications.

But as the government contractor, Express Scripts decides which pharmacies are in the Tricare retail pharmacy network and how much they are reimbursed.

Since 2022, more than 13,000 local pharmacies have left the network, leaving nearly 400,000 military families scrambling to find a new pharmacy in network, Warren said.

Currently, there are 46,000 retail pharmacies across the country that voluntarily participate in the Tricare retail pharmacy network, Kautzner said. As a result, 98% of beneficiaries have a retail option within 15 minutes of their home, he said, which exceeds the contract requirements.

Of the 46,000 pharmacies in the network, 16,000 are independent pharmacies.

Among those pharmacies that left the network was Roden-Smith Pharmacy in Clovis, N.M. Its owner, Micah Lansford, testified that the terms of the contract Express Scripts offered his pharmacy forced them out of the program in 2023.

Under the previous contract, the pharmacy had been reimbursed an average of about $0.37 below their actual cost for the 6,750 prescriptions they filled, causing the pharmacy to lose nearly $2,500 in 2022.

Under the terms of the contract Express Scripts proposed for 2023, Roden-Smith would have lost nearly $9 on average for each prescription and $60,000 for the same volume in 2023.

Lansford described the real-life consequences for the military community of. having fewer local pharmacies.

“Community pharmacies like mine provide a higher level of personal care, easier access,” he said.

He gave the example of a disabled U.S. Air Force retiree, whose caregiver relied on Lansford to review each monthly fill of medications, reconciling any changes and making sure his medications still made sense.

He also spoke of young active duty spouses who could no longer use his pharmacy drive-thru to pick up an antibiotic for their child, but are instead waiting in long lines to get onto base, hoping the antibiotic is in stock at the military pharmacy.

Greg Reybold, vice president of the American Pharmacy Cooperative, which includes about 1,500 independent pharmacies, said while Express Scripts touts the savings of the mail order pharmacy, it’s cheaper to fill prescriptions at the retail pharmacies than through Express Scripts mail order.

Filling generic drugs at Tricare retail pharmacies is cheaper for beneficiaries, and for the Defense Health Agency, he said. If for example, the drug costs the pharmacy $3, the beneficiary pays that instead of the usual $16 Tricare copay.

When 13,000 retail pharmacies left the network, he said, “the only winner was the Express Scripts mail order pharmacy,” because beneficiaries were forced to use that pharmacy.

Reybold and Lansford both called for an independent audit of the pharmacy program.

“We have a strong desire to serve these people, and want to be there for them,” Lansford said. “And we want a fair deal to provide service.”

Under the new memorandum of understanding, VA and HHS plan to increase clinical trial participation, train therapists, nurses and doctors to administer psychedelic medications if they receive federal approval and collect data and evidence to support patients, physicians and federal regulators in considering such treatments.

The agreement follows an executive order signed in April by President Donald Trump that directed the Food and Drug Administration to accelerate its review of several psychedelic treatments for mental illnesses.

The order largely addressed research for ibogaine, a hallucinogen derived from an African shrub, that some veterans have found helpful in ameliorating anxiety, PTSD and depression symptoms. It commits at least $50 million to increase research on ibogaine therapy.

Studies on PTSD in the general population have shown that a third may be resistant to traditional treatments, with up to 50% not responsive to psychological therapy and 40% untreatable with common medications.

An estimated 4.8 million American veterans have used psychedelic drugs, according to a study released last month by the think tank RAND.

Included in Monday’s message was the announcement that the VA signed an agreement with the Food and Drug Administration to increase collaboration to support the development of therapies for treating serious mental health conditions.

“President Trump opened up a world of possibility for treating veterans and others with mental health conditions, and VA is proud to be part of this important work,” VA Secretary Doug Collins said in a statement. “Today’s MOU ensures effective cooperation with HHS as we try to turn research into life-changing treatment.”

VA researchers are involved in more than 20 research trials on the use of psychedelics like MDMA and psilocybin for treating severe post-traumatic stress disorder, depression, substance abuse and other mental health conditions.

Studies also are underway in the Defense Department: a $4.9 million research study is ongoing at Walter Reed National Military Medical Center in Bethesda, Maryland, on the effectiveness of MDMA — known commonly as Molly or Ecstasy — for the treatment of mild to moderate PTSD.

According to RAND, the most common hallucinogens used by veterans across their lifetimes were LSD, with 19.6% reporting its use, followed by psilocybin, or magic mushrooms at 18.6%, MDMA and mescaline, both at 7.7%.

Fewer than 2.9% reported using another type of hallucinogenic drug such as ibogaine, ketamine or ayahuasca.

The study also found that veterans were more likely to support the legal use of psilocybin mushrooms and LSD — 23% for mushrooms and 11% for LSD — but support for MDMA, at 9%, was about the same as the rest of the country.

Ron Adkins, an Army Reserve intelligence analyst and veterans advocate who deployed twice to Afghanistan, was on hand Monday for the MOU signing. He said the significance of the agreement lies in exploring new approaches to “the complexity of mental illness.”

“The cognitive space is a very complex environment. We are all very different people, so the treatments that might work very well for one person could be wholly ineffective for another,” Adkins said in an interview with Military Times. “I’m hoping we get better answers on what is effective for [veterans] trying to figure this out.”

U.S. veterans have traveled to Israel, Mexico and elsewhere in the past decade to receive psychedelic treatment for mental health disorders, often paying thousands of dollars out of pocket for the promise of relief.

Adkins said that should not happen.

“We need to continue to innovate as we as a nation does,” Adkins said.

In 2024, the FDA rejected a request that MDMA be approved for treating PTSD in adults, saying more research was needed to determine its safety and efficacy. The VA is conducting such a study in Providence, Rhode Island, with 80 veterans, comparing MDMA-assisted therapy for PTSD and substance use with a placebo.

VA officials say while the department is studying treatments that use Schedule I drugs prohibited in the U.S. under federal law, veterans are discouraged from self-medicating with these substances or replacing their medical treatment with unprescribed substances.

“Proven, evidence-based treatments, are currently available at VA facilities to treat veterans with mental health conditions. Veterans should always consult their health care providers before making any treatment decisions,” officials said in a press release.

In a letter to one beneficiary dated July 2 and provided to Military Times, TriWest officials said they had discovered a security incident April 16, in which an unauthorized person gained limited, unauthorized access to TriWest information and downloaded it.

“We are unaware of any misuse of your information,” officials stated in the letter, but they went on to say TriWest is offering a free credit-monitoring service for those who feel it’s needed.

The unauthorized person obtained health-related and other personal information, specifically names, Department of Defense Benefits Numbers and beneficiaries’ ZIP codes. Officials said that in fewer than five instances, the information also included Social Security numbers, addresses and dates of birth.

About four million beneficiaries are covered by TriWest, the managed care contractor for the Tricare West Region. Active duty, retired, National Guard and Reserve, and their family members, survivors and certain former spouses receive their health care under DoD’s Tricare program, with eligibility determined by the Defense Enrollment Eligibility Reporting System, or DEERS.

TriWest is notifying each beneficiary about what information was involved in their specific case.

The timing of the notifications was unclear, since at least one letter was dated July 2, about two and a half months after the incident occurred.

“With regard to timing, as soon as the incident was discovered, TriWest took immediate action to prevent any further unauthorized activity and worked diligently with the government to notify affected individuals, consistent with applicable law and notification timelines,” TriWest officials said in an email response to Military Times.

The company hired a third-party forensic expert to review what information was accessed during the incident.

Beneficiaries who want to use the free credit-monitoring service, offered through Experian for 24 months, should enroll by the deadline provided in their notification letter, using the activation code and instructions included in the letter.

Those who find suspicious activity should notify the TriWest Healthcare Alliance Breach Response Line, at 1-833-918-1296. Beneficiaries who believe they are victims of identity theft should file a report with the Federal Trade Commission at identitytheft.gov.

The company has taken steps to prevent any other such incidents, officials said, including increasing security controls related to password resets, strengthening system access monitoring tools and providing additional employee education on identifying and mitigating the different types of cyber attacks.

These are the first payments for settlements resolving about 3,600 claims resulting from the poisoned water, which caused numerous health problems for military families living in military housing, and for other civilian families in Hawaii whose water was provided by the Navy.

Another 3,000 people haven’t accepted the government’s offer, which their attorney describes as “paltry.”

And service members affected have received no payments, said Kristina Baehr, attorney for the plaintiffs in two federal court cases filed against the government. That issue is on appeal to the Ninth Circuit.

‘A step in the right direction’

Service members and family members reported numerous health problems, including diarrhea and other gastrointestinal problems, rashes, neurological issues, burns, lesions, thyroid abnormalities, migraines and neurobehavioral challenges.

“The United States’ settlement payments to hundreds of Red Hill families are a step in the right direction,” Baehr said. “Every dollar paid represents some measure of accountability for families who were exposed to fuel-contaminated water in their homes, suffered injuries, and then were forced to fight their own government for recognition and relief.”

The lawsuits, filed in U.S. District Court in Hawaii, alleged negligence in at least two separate events — in May and November 2021 — at the Red Hill Bulk Fuel Storage Facility, which contaminated the Navy’s water distribution system.

Some 9,715 households in Navy, Army and Air Force neighborhoods were affected by the November spill. Those storage tanks have since been drained.

The first wave of these settlements for the 629 plaintiffs was approved by the Hawaii court on May 19, and their payments were issued on June 22, Justice officials said.

Justice officials have reached settlements with about 3,600 plaintiffs in the two lawsuits following a federal judge’s orders in 2024. Payments for those settlements are in various stages. The two lawsuits include about 6,500 people.

“This Justice Department is proud to announce the efficient resolution of claims relating to the Red Hill jet fuel spills that harmed American service members and their families,” Associate Attorney General Stanley Woodward said in an announcement of the payments. “These latest settlements prove our commitment to ensuring justice for our nation’s heroes who repeatedly risk greatly to safeguard our freedoms.”

Baehr questioned that statement.

“No dollars are going to America’s heroes,” she said.

“This Department of Justice proclaims that it is ensuring justice for America’s heroes by way of these paltry settlements,” she said. “[It] doesn’t mention that they have paid zero dollars to service members. [DOJ] argued in court that service members should be dismissed from their Red Hill contamination claims because when they bathed their babies at home and bathed themselves naked in their showers, those were incident to military service because they occurred in military housing.”

3,000 fight for higher settlement

All of the 629 people received payments of about $27,000, she said.

“The government undercut the court’s order” on the amounts of damages in its offers to the plaintiffs, Baehr continued. “The government is legally permitted to do that, but it can’t then proclaim they’re ensuring justice for America’s heroes when they’re avoiding the court’s order on damages.

“The government had an opportunity to settle all claims in this case, if they had made an offer within the court’s order on damages. Instead they made this lowball offer,” she said.

The remaining 3,000 who declined the offer “wanted to make sure there is accountability in this case, and are going to hold the government to the court’s order.”

Justice officials are making “good faith efforts” to resolve the more than 6,500 claims from the Red Hill spills, said Assistant Attorney General Brett A. Shumate of the Justice Department’s Civil Division. “The settlements represent a fair and just resolution of claims and we look forward to paying additional claims once they are approved.”

The Red Hill disaster wasn’t just about an environmental failure, Baehr said. Rather, “it was failure of trust between the government and the military and civilian families it is obliged to protect.”

The Navy initially told families the water was safe to drink, and families allege they weren’t provided adequate medical care. The Navy later moved families to hotels while they worked to flush the system. Navy officials acknowledged their operator error caused the problem.

“Until every affected family is treated fairly, until injured service members have their day in court, and until the full consequences of Red Hill are acknowledged, this matter is not over,” Baehr said.

In the last month, the government has settled with two of her clients with numbers that are within the court’s order — one at $45,000 and another at $50,000.

“We’re thankful for it,” Baehr said. “We believe the justice system can make it right, and we believe they will, but it’s not yet.”

The Department of Veterans Affairs offers care to address menopause symptoms such as hot flashes, night sweats, brain fog and sleep issues, and it is developing physician guidelines on assessing, diagnosing and treating health issues that occur when hormone levels drop in patients.

But while VHA has developed resources like brochures and a website to teach women on their care options, 60% of 348 female veterans surveyed said they had never seen these materials, according to a Government Accountability Office report published June 12.

And VA hospital and clinic officials said they faced difficulties finding the time to discuss these resources with patients, GAO analysts found.

Women make up the fastest growing group in the veteran population, from 4% in 2000 to an anticipated 18% by 2040. More than half of the 687,000 women veterans who receive medical care at the VA care are between the ages of 45-64, the age range when most experience perimenopause and menopause, the cessation of their periods.

Given this growing population, members of Congress asked the GAO to study the VA’s treatment options and educational resources for patients going through this change.

The GAO found that VA offers broad access to medical care for menopause symptoms and has services tailored specifically to support veterans who are more likely to have concurrent conditions such as chronic pain and post-traumatic stress disorder than the general population.

Without knowing that this care is available, however, women veterans may not know to bring up their symptoms with their VA health care providers, GAO analysts wrote in “VA Menopause Care: Actions Needed to Help Ensure Quality Care and Patient Education.”

In the past several years, the medical establishment and women have been more open about menopause, prompted largely by new research that shows a common treatment for symptoms — hormone replacement therapy — is less likely to be linked to cardiovascular disease and breast cancer than previously thought.

And women’s health is being taken more seriously than ever before, according to Gloria Bachmann, co-director of the Women’s Health Institute and associate dean for Women’s Health with Rutgers Robert Wood Johnson Medical School.

The FDA removed its “black box” warnings from hormone replacement therapy for menopause symptoms in October, and in addition to the new research, “society does not look at menopause in such a negative way anymore,” Bachmann said during a Rutgers media interview at the time.

“We now have many role models who are in their 50s and 60s, and they’re not considered old. They are still seen as attractive and productive. Many actors and political individuals are of menopausal age, and we still respect them very much,” Bachmann said.

The GAO report said that instituting the clinical practice guidelines that are in development and ensuring they are followed as well as educating patients on menopause could “help VHA better meet its goal of providing women veterans with comprehensive health care.”

The GAO recommended that VA use performance measures to ensure that its new clinical guidelines are implemented and develop strategies to ensure that veterans understand the resources available at the VA to learn about and treat menopause.

The agency provided a copy of the report to the VA for review and response but the department did not provide comment, according to the GAO.

New York Sen. Kirsten Gillibrand, the ranking Democrat on the Senate Aging Committee, was among the lawmakers who requested the study. She has been at the forefront of advocacy for women’s health, sponsoring legislation in 2024 with 16 other senators to encourage federal research on menopause and coordinate federal programs across health agencies.

“Menopause care is essential healthcare for female veterans and the VA must not treat it as an afterthought,” Gillibrand said in a statement Monday to Military Times. “I will hold the VA’s feet to the fire until every veteran has the resources they need to age with dignity.”

Rep. Julia Brownley, D-Calif., sponsored a House bill last year requesting the GAO review. She said Monday that the report made “clear that more must be done” to ensure that veterans have access to information and treatment.

“Beyond these symptoms, these transitions mark critical health inflection points that can affect a woman’s long-term health and well-being,” said Brownley in a statement to Military Times. “That is why I’m working alongside Sen. Gillibrand and my colleagues on the House Committee on Veterans Affairs to close these gaps in care, strengthen education and outreach for women veterans and ensure VA is fully implementing evidence-based menopause care across its health system.”

The VA is launching a program of regional summits for women veterans next month in San Antonio to encourage women veterans to enroll with the VA and consider VA health care.

The “Boots on the Ground for Boots on the Ground” summits will take place through May 2027 and are sponsored by the VA Center for Women Veterans and the Office of Women’s Health.

In December, the department lifted a requirement that veterans need a referral from their primary care physician to schedule an appointment for gynecological care.

VA Secretary Doug Collins said the department is shifting to ensure that it works better for all veterans, regardless of sex.

“This is what it looks like when VA is focused on putting veterans first,” Collins said in a statement. “By relentlessly focusing on customer service and convenience, we are building a department that works better for the men and women we are charged with serving.”

The Government Accountability Office looked at the Tricare Extended Care Health Option, known as ECHO, and its ECHO home health care benefit, known as EHHC. Military families may face challenges getting access to these services, which help individuals keep, learn or improve skills and functioning for daily living; provide durable medical equipment and incontinence supplies; and offer caregiver support, such as respite care.

Families with special needs may have difficulty getting access to the services they need, especially because of frequent military moves.

The coverage may be outdated, with the amounts at the same level since 2009, auditors noted in a GAO report published Monday.

Because of rising health care costs, the Defense Health Agency “lacks reasonable assurance that ECHO benefits, including EHHC services, are fully meeting the program’s purpose of mitigating the disabling effects of a qualifying condition,” auditors stated.

The coverage limit for the ECHO program has remained at $36,000 per enrollee per calendar year since 2009, when lawmakers last authorized an increase.

Auditors said that with inflation, that equates to about $24,000 in 2025 dollars.

About 27,000 eligible dependents were enrolled in ECHO in 2024, according to DoD. Most of these are children with intellectual, developmental or physical disabilities or other significant health needs.

Eligibility and other requirements and coverage vary between the service branches. Of the total ECHO population, about 1,000 were homebound with complex medically complex conditions and qualified for the ECHO home health care benefit.

But out of those 27,000 enrolled, only about 4,235, or 16%, used the ECHO services, auditors stated.

In their response to a draft report, DoD disagreed with the GAO recommendation to assess whether the coverage limit of $36,000 is enough.

They stated that in 2024, the 4,235 enrollees had an average total government expenditure of $6,600. That $36,000 coverage limit is set by law; those who require the ECHO home health care services aren’t subject to the cap. Auditors noted that a review could provide information for any potential congressional action.

Lawmakers required GAO to conduct this review of the coverage for nursing care, habilitative programs and respite care through Tricare ECHO and other federal programs.

ECHO respite care services must be provided by a Tricare-authorized home health agency, to provide a short-term break for the usual caregiver. The ECHO program allows up to 16 hours per month.

The auditors also reviewed state Medicaid home- and community-based services, such as skilled nursing care and respite care, in seven states with high military populations.

Military families may be eligible for this care, which in some cases may offer more benefits than ECHO, but access can be limited. Auditors cited a study that found in 2025, it took about 32 months to move from a waiting list to enroll in one of these state programs. Families have said that by the time they can receive the services in a state, it’s time for them to move.

DoD is in the process of standardizing its eligibility requirements, and the number of respite care hours offered across all the military service branches through the Exceptional Family Member Program. DoD officials told GAO auditors that they expect to fully implement standardization of the respite care services by October 2027, and those with profound need would be eligible for up to 32 hours of respite care per month.

Of all the services GAO auditors reviewed, respite care was the most frequently requested from 2022 through 2024, according to data from one of the Tricare managed care contractors.

But about 68% of the authorizations for services weren’t used by the families. Defense Health Agency officials told auditors shortages of respite care providers may contribute to unused services. The shortage can also delay or limit access to nursing care services for military families.

Low respite care hours and low reimbursement offered by ECHO may also contribute to challenges in getting providers, according to the GAO report.

Two ECHO case managers told auditors that even if the respite hours increased to 32 hours per month, it would still be hard to find providers, since respite care providers want more hours than that.

The panel’s personnel subcommittee has proposed limiting the DoD’s plans to restructure the military health system and called for reversing any changes the department has made to 41 military treatment facilities.

The subcommittee’s draft of the fiscal 2027 National Defense Authorization bill also would improve congressional oversight of military medical reforms by requiring the Defense Health Agency to give quarterly updates to Congress of its plans to change the system.

The proposals stem from a massive overhaul of the military health system reforms initiated under the fiscal 2017 National Defense Authorization Act, which called for transferring military hospital and clinic management to the Defense Health Agency and reducing administrative redundancies across the system.

The legislation ultimately aimed to focus the military health system on training military medical personnel for combat operations and caring for active-duty troops, and placing non-military patients in private sector care covered by the DoD.

As a result of the reforms, DHA and the military services planned to restructure the entire hospital system, announcing in 2020 that it would improve two military medical centers and consolidate or downsize 48 facilities, including 38 that would no longer see military families or retirees as patients.

At the time, Thomas McCaffery, who served as assistant secretary of defense for health affairs in the first Trump administration, said the changes were necessary to prepare military physicians and troops for deployment.

“We reviewed all facilities through the lens of their contributions to military readiness — that includes MTFs [being] operated to ensure service members are medically ready to train and deploy,” McCaffery said in a 2020 report to Congress.

But those reforms bled patients from military heath facilities, resulting in inadequate numbers for military physicians to maintain their skills. In turn, services degraded across many military hospitals and clinics, according to senior enlisted personnel.

In late 2024, the Defense Department reversed course on the plan to shed patients to private care, vowing to bring back 7% of patients by the end of 2026. It also has announced several partnerships with community health facilities to ensure that military physicians get adequate trauma training and patient exposure to maintain their skills.

But the DoD has failed to provide information to Congress regarding the reforms, frustrating members with its lack of candor regarding any planned closures of facilities.

Concerns voiced by lawmakers over changes to facilities that weren’t made public, such as Keller Army Community Hospital, West Point, New York, which was to lose its inpatient beds and Fort Leonard Wood’s new hospital. That hospital was to open not as a full-service hospital as planned, but an ambulatory clinic, which prompted several legislative changes, including the proposed fiscal 2027 NDAA restrictions.

Under the draft NDAA, DHA would not be allowed to make changes proposed for 41 facilities and must “reverse any steps to carry out a service change” and “restore personnel and clinical services affected by any such service change to a level that existed as of March 3, 2026.”

According to the proposed legislation, three facilities faced downsizing from hospitals to ambulatory care facilities, meaning they would have no inpatient capabilities. Those included:

• Eisenhower Army Medical Center, Fort Gordon, Georgia;
• 88th Medical Group, Wright-Patterson Air Force Base, Ohio, (including closing pediatric cardiology and discontinuing chiropractic care); and
• Naval Hospital Beaufort, South Carolina, including discontinuing chiropractic care.

Those that would limit access to active-duty service members only included:

• 78th Medical Group, Robins Air Force Base, Georgia;
• 72nd Medical Group, Tinker Air Force Base, Oklahoma;
• 75th Medical Group, Hill Air Force Base, Utah; and
• 66th Medical Squadron, Hanscom Air Force Base, Massachusetts.

Those that would have excluded caring for retirees and their dependents, only seeing active-duty personnel and their family members were:

• 22nd Medical Group, McConnell Air Force Base, Kansas;
• 341st Medical Group, Malmstrom Air Force Base, Montana;
• 28th Medical Group, Ellsworth Air Force Base, South Dakota;
• 92nd Medical Group, Fairchild Air Force Base, Washington;
• 90th Medical Group, Francis E. Warren Air Force Base, Wyoming;
• 355th Medical Group, Davis-Monthan Air Force Base, Arizona;
• 9th Medical Group, Beale Air Force Base, California;
• 45th Medical Group, Patrick Space Force Base, Florida;
• 4th Medical Group, Seymour Johnson Air Force Base, North Carolina;
• 460th Medical Group, Buckley Space Force Base, Colorado;
• 27th Special Operations Medical Group, Cannon Air Force Base, New Mexico;
• 412th Medical Group, Edwards Air Force Base, California;
• 30th Medical Group, Vandenberg Space Force Base, California;
• Naval Health Clinic Corpus Christi, Texas;
• 19th Medical Group, Little Rock Air Force Base, Arkansas, (which also plans to discontinue nutrition services); and
• 20th Medical Group, Shaw Air Force Base, South Carolina, (which also plans to discontinue nutrition services).

Facilities planning to restrict services only to active duty members and dependents who live on base included:

• 23rd Medical Group, Moody Air Force Base, Georgia;
• 366th Medical Group, Mountain Home Air Force Base, Idaho
• 319th Medical Group, Grand Forks Air Force Base, North Dakota; and
• 61st Medical Squadron, Los Angeles Space Force Base, California.

Three facilities were slated to discontinue contracts for chiropractic and nutrition services, including:

• 55th Medical Group, Offutt Air Force Base, Nebraska;
• 2nd Medical Group, Barksdale Air Force Base, Louisiana; and
• 87th Medical Group, Joint Base McGuire-Dix-Lakehurst, New Jersey.

In addition, the following facilities would discontinue contracts for chiropractic services:

• 1st Special Operations Medical Group, Hurlburt Field, Florida;
• 10th Medical Group, U.S. Air Force Academy, Colorado; and
• 96th Medical Group, Eglin Air Force Base, Florida.

Seven facilities would have seen changes in services, to include:

• David Grant Medical Center, Travis Air Force Base, California, slated to lose its labor and delivery department;
• 42nd Medical Group, Maxwell Air Force Base, Alabama, which would stop its educational and developmental intervention services;
• Vilseck Army Health Clinic, Germany, which would discontinue its physical medicine and rehabilitation services;
• Naval Health Clinic Patuxent River, Branch Health Clinic Dahlgren, Virginia, which would no longer offer radiology;
• Army Health Clinic Munson, Fort Leavenworth, Kansas, which would stop offering mammography;
• Naval Health Clinic Lemoore, California, which would lose its operating rooms;  and
• 7th Medical Group, Dyess Air Force Base, Texas, which would stop offering nutrition services.

And according to the proposed legislation, one facility — the Desert Sage Community Based Medical Home, part of William Beaumont Army Medical Center, at Fort Bliss, Texas — was slated for closure.

In October, then-acting Assistant Secretary of Defense for Health Affairs Dr. Stephen Ferrara said review of the military health system was an ongoing process and no plans for reductions or closures were set in stone.

“Like any enterprise, we’re always looking at ‘Where are we there — where do we have supply and demand mismatches?’ That’s just good governance of the system,” Ferrara said in response to a question from a reporter at a Military Officers Association of America conference.

“If you looked at any corporation that had 100 hospitals or 100 stores, they should be looking at them to say where it makes sense to dedicate their resources. That’s kind of what we’re doing, just as a matter of course, so there’s not, like, a list,” Ferrara said.

Karen Ruedisueli, MOAA’s director of government relations for health, said Tuesday that the organization, which represents active-duty and retired military personnel and family members, continues to press pressed Congress and the Defense Department to conduct “rigorous data-based analysis and mitigation planning” before shifting patients from military facilities to civilian care.

Ruedisueli first reported on the facilities list in the proposed legislation Tuesday.

“MOAA will keep members informed as this legislation moves forward and work to ensure any changes to the MHS prioritize the needs of those who have served,” Ruedisueli wrote in a blog post.

The House Armed Services Committee plans its mark up of the fiscal 2027 NDAA Thursday. It then will be forwarded to the full chamber for consideration. The Senate Armed Services Committee plans to mark up its version next week but has not released a draft.

For the second year , no VA hospitals received a one-star rating from the Centers for Medicare & Medicaid Services, or CMS, the agency within the Department of Health and Human Services that publishes quality assessments for U.S. hospitals based on mortality rates, patient safety, hospital readmissions and other measures.

CMS began rating VA hospitals in 2023. That year, of 114 facilities that were evaluated, nearly 30% received five stars; 37% received four stars; 15% were awarded three stars; 11%, two stars; and 8% — or nine facilities — one star.

In 2026, 45% of VA facilities received five stars, 33% earned four stars, 16% received three stars and 6% were given two stars.

Since the first assessment, the percentage of VA facilities that have earned four or five stars rose from 67% to 78%, despite dipping to 58% in 2024.

The assessments compare favorably against more than 4,600 hospitals reviewed by CMS nationwide. Roughly 12% of U.S. hospitals received five-star ratings, 30% were awarded four stars, 31% received three stars, 21% earned two stars and 6% were given one star this year.

Officials said the new ratings mean VA hospitals account for nearly 15% of the country’s five-star rated hospitals.

“The Trump Administration has a proven track record of improving Veterans’ care, and these ratings underscore that success,” VA Secretary Doug Collins said in a release. “We look forward to continuing to deliver the results veterans have earned at VA facilities across the nation.”

The list of high- and low- performing facilities at the VA has fluctuated over time, with some marked improvements in facilities that received one star in 2023.

For example, the VA Pittsburgh Health Care System, Providence VA Medical Center in Rhode Island and the Bronx VA Medical Center in New York City each received one star in 2023 but earned four stars in 2026.

Two facilities that earned one star each in 2023 continue to be among the VA’s list of facilities performing under national averages on several measures. The Overton Brooks VA Medical Center in Shreveport, Louisiana, and the San Juan Medical Center, Puerto Rico, are among the seven VA facilities that received two stars.

The VA maintained its own internal star ratings and began publishing them in 2017 following a series of news reports. In late 2019, the department dropped the effort because VA leaders said it provided little value to veterans.

Twenty Veterans Health Administration medical centers were not rated because they did not meet the criteria for inclusion. CMS does not rate facilities that have a low number of cases or incidents that are specific to its assessment criteria.

It also does not rate specialty hospitals, ambulatory surgical centers and some inpatient care facilities, such as psychiatric hospitals.

The CMS star ratings can be found on Medicare’s Care Compare website.

In a short statement, the Defense Commissary Agency said only that the change took effect Wednesday and applied to commissaries worldwide. Commissaries in states or localities that mandate bags fees would still have to comply with those laws.

“The policy, introduced on April 6, which required commissary patrons to pay for single-use plastic and paper bags, has been rescinded,” the statement reads.

In a separate statement, Rep. Jen Kiggans, R-Va., a former Navy helicopter pilot, took credit for the reversal, saying the commissary agency’s decision followed months of advocacy.

Kiggans penned a letter to Anthony Tata, undersecretary of defense for personnel and readiness, and she spoke about the issue directly with Defense Secretary Pete Hegseth after his testimony before the House Armed Services Committee last week, she said.

“I was deeply frustrated when DeCA announced it would impose a charge for paper and plastic bags — an added cost that complicates a benefit intended to support our service members, retirees and their families,” Kiggans said in a statement. “I appreciate Secretary Hegseth for listening to my concerns and taking swift action to eliminate this fee.”

The policy required commissary customers to pay 5 cents each for plastic bags and 10 cents for paper bags.

Providing the single-use bags costs the commissary agency $17 million per year, spokesperson Keith Desbois said when the agency announced the policy in March.

The commissary agency receives about $1.5 billion per year in taxpayer dollars to operate these discounted grocery stores as a benefit for the military community.

The Defense Department’s goal is an overall savings of 25% compared to commercial stores outside the gate.

Military Times reporter Karen Jowers contributed to this story.