Military families with special needs children face a program meant to ease permanent change-of-station moves and ensure medical and educational support, yet many describe it as a source of added stress rather than relief. Enrollment now covers roughly 105,700 service members and 136,800 family members, or about 8 to 9 percent of the force, according to the Defense Department’s latest annual report to Congress.
Still, a 2022 Defense Department-wide survey found only 43 percent of active-duty sponsors were satisfied with the Exceptional Family Member Program overall, while 33 percent were dissatisfied. Assignment coordination during moves drew even lower marks, with just 33 percent satisfied.
In an exclusive interview with Military.com, Jeremy Hilton, a Navy veteran and Air Force spouse who has advocated for EFMP improvements for more than 23 years, said the program’s execution still falls short of its readiness mission.
Hilton, whose daughter Kate was born in 2002 with severe hydrocephalus and complex medical needs, left active duty to become her full-time caregiver. He has testified before Congress, briefed Pentagon officials, and pushed for reforms through writing and direct engagement with lawmakers and military leaders.
EFMP’s Intent Versus Execution
Hilton explained that EFMP began as a medical support tool and grew into a congressionally mandated program to help families during frequent moves. Over time, advocacy expanded its scope to include educational services and therapies such as applied behavior analysis for autism. “Its intent has changed because we have advocated along the way,” he said. But a program that exists on paper to provide stability is, in practice, often the very thing that destabilizes a military family’s life.
This destabilization is largely the result of a fragmented organizational structure where policy is set in one office, but execution is scattered across multiple commands. No single senior leader oversees the program end-to-end.
The Department of War Office of Special Needs sets policy, but each military service runs its own EFMP, the Defense Health Agency handles clinical access, and assignment commands make the final calls on moves. That fragmentation creates silos, Hilton noted, and means congressional mandates often fall flat.
A 2023 Defense Department inspector general audit reached a similar conclusion. It found the Office of Special Needs had not fully implemented earlier Government Accountability Office recommendations on data collection, performance metrics, or installation-level gap reporting. Without comparable data across services, officials cannot measure effectiveness or fix shortfalls in medical or educational resources before families arrive at a new base.
Data Shows Mixed Results and Retention Risks
The numbers back up the frustration. The 2022 EFMP survey showed 26 percent of sponsors said enrollment negatively affected their decision to stay in the military, while only 25 percent said it had a positive impact. During permanent change-of-station moves, just 49 percent reported that EFMP family support made the transition smoother.
Hilton then pointed to the real-world consequences of this bureaucratic landscape. Frequent moves disrupt therapies, school Individualized Education Programs (IEP), and Medicaid waivers that many families rely on. When services are unavailable at a gaining base, assignments get canceled or families accept unaccompanied tours, which strains careers and retention.
One 2021 analysis estimated that poor EFMP support costs the force hundreds of millions in replacement training when skilled personnel separate early.
Hilton referenced Partners in PROMISE's “State of Military-Connected Children with Disabilities” and ongoing LinkedIn series, including the recent “Making EFMP Great Again” (or MEGA) action plan. He argues the program touches everything from assignments to health care and housing, making it a leading indicator of overall family readiness.
Advocates Push for Accountability and a Unified Approach
Hilton’s core recommendation is straightforward: put someone in charge. He calls for a joint program office or a designated senior leader with cross-service authority to enforce standards and replicate proven models. One example: Joint Base McGuire-Dix-Lakehurst (JBMDL) developed a strong EFMP practice in 2020 that the Air Force recommended other installations to copy, yet few have done so.
He also backs designating EFMP as a High Impact Service Provider for better oversight and resources, plus stronger metrics on assignment match accuracy and post-move care continuity. In his MEGA plan, Hilton urges Pentagon leaders to activate unused 2011 authorities for innovation, expand successful pilots like CareStarter, and tie funding to measurable outcomes.
Past wins show that advocacy works. When the Defense Health Agency questioned the evidence for ABA, families pushed back. Congress ordered a National Academies review, which sided with military families and rejected the agency’s stance. Similar congressional pressure reversed earlier TRICARE reimbursement cuts that threatened autism therapy access.
Hilton’s earlier writings, including a 2017 Huffington Post piece on patterns of delayed reforms, highlight how slow change leaves families in limbo. A recent letter from Sen. Patty Murray to the Pentagon pressed for details on coordinator staffing and implementation of the 2023 DoD instruction meant to standardize offices at service headquarters and installations.
What Families Can Do While Reforms Lag
Hilton advised families to document needs thoroughly, stay enrolled despite assignment fears, and connect with local EFMP coordinators early. He maintains a Dropbox archive of two decades of documents for those ready to dig deeper and offers to make introductions to key players in the space.
As noted in a previous Military.com opinion piece on how the military can streamline moves for families with special needs, small improvements in coordination pay big dividends for retention.
Hilton’s message after 23 years remains persistent but practical. “We either need to hold the services accountable or create a joint program,” he said. With roughly one in 10 service members touched by EFMP, fixing these bureaucratic hurdles is not just a family issue. It is a readiness imperative. Advocates like Hilton continue pressing for the accountability and standardization that turn good intentions into consistent support.
