Open Source Health with Tripp Johnson

TRICARE’s Quiet Cuts: Why Mental Health Care for Veterans Is at Risk

• Tripp Johnson • Season 5 • Episode 99

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In this urgent solo episode, Tripp Johnson, CEO of Advaita Health and a veteran himself, sounds the alarm on a major policy change from TRICARE that quietly went into effect in January 2025. While it hasn’t made national headlines, the consequences are real and devastating for psychiatric nurse practitioners, physician associates, and—most importantly—the military families they serve.

TRICARE has stopped reimbursing psychotherapy add-on codes for NPs and PAs, slashing pay by up to 50% for comprehensive mental health visits. This bureaucratic decision undermines integrated care, threatens patient-provider relationships, and risks pushing more veterans and service members out of treatment altogether.

Tripp breaks down:

What changed in TRICARE’s reimbursement policy

Why this decision makes access to care worse, not better

How it impacts providers, clinics, and most critically, patients

Why this isn’t just a billing issue—it’s a values issue

What providers, patients, and policymakers can do right now

This episode is a call to action. If you care about mental health access for those who’ve served, this is your moment to listen, share, and speak up.

Takeaways:
• TRICARE has eliminated reimbursement for psychotherapy codes for NPs and PAs
• Reimbursement drops by up to 50% per visit, making care unsustainable
• Providers are reconsidering TRICARE participation nationwide
• Veterans risk losing trusted relationships and access to care
• Action is needed—from clinicians, patients, and policymakers alike

Chapters:
00:00 – A change no one is talking about
01:12 – What this means for providers and patients
02:30 – The business model impact
03:33 – This is a values issue, not a billing issue
04:25 – What you can do about it

Listen. Share. Raise your voice. This isn’t just about policy. It’s about people.

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Tripp Johnson

  • LinkedIn: https://www.linkedin.com/in/trippjohnson
  • Instagram: https://www.instagram.com/trippjohnson
  • Website: https://www.trippj.com/

Hey everyone, Tripp here. I want to talk today about something that didn't make the headlines but should have. Earlier this year, TRICARE quietly changed how it reimburses psychiatric providers. It's a policy shift that sounds technical, but in reality, it's already affecting the lives of active duty service members, veterans, and their families. And the worst part, most people don't even know it happened. So what changed? Tricare is the insurance plan that covers millions of active duty service members, veterans, and their families. Up until this January, psychiatric, health, nurse practitioners, and physicians assistants could bill for both parts of a typical mental health visit, medication management, and psychotherapy. That's what comprehensive care looks like. You evaluate these symptoms, adjust medications, but you also spend time talking with the patient, listening. building trust, helping them work through what's actually going on with evidence-based practice. That type of visit is typically billed as a 99214 for the medical portion and a 90833 for the psychotherapy. Combined, the provider gets paid about $150. It's fair for the time and training involved, and this is what is typically involved in a 30-plus minute visit. Now, TRICARE no longer reimburses the second part, the therapy. So if you're a nurse practitioner or a PA, same visit, same time, but now that's going to pay $100 instead of $150. This is a huge deal. TRICARE is already one of the lowest reimbursing insurance plans. That means that the people who are in network with TRICARE are doing this out of the goodness of their heart because they believe in providing access to life-saving care. So what's going to happen now? This is the kind of care that is not going to be possible in the future. Comprehensive care where you actually spend time with your provider. What TriCare is basically saying to us is just write the prescription and get them out the door. This is, again, has already been a huge problem for us because Tricare is one of the lowest reimbursing insurance carriers. That's why they have such a hard time finding care if you're an active duty service member or veteran. At our organization, we've had to run the numbers. We've had hard conversations about whether we can keep seeing Tricare patients. And I know we're not alone. Across the country, providers are rethinking their participation, not because they want to. but because TriCare is making this unsustainable. And so who really pays the price? Obviously practices and providers are hurt in their business model, but the ones that I care about most are the patients and especially those who've served like I have. The people who put everything on the line and are often waiting too long for care. The ones managing trauma, depression, all sorts of moral injury, often in silence. They're the ones who are at risk when providers leave the network. If they lose access to the person they've built trust with, it's not just an inconvenience. It can undo months of progress, or worse, can keep someone from getting the help they need altogether. So what we're really talking about is the policy that supports mental health care. If we want to reduce veteran suicide, we have to have effective policy. This is about honoring those who served. But if we're not willing to pay for that care that actually helps, then those words don't mean shit. This isn't just a billing issue, it's a values issue. Therapy and medication management aren't separate in the real world, not for the people receiving care and not for the providers delivering it. Breaking this apart doesn't improve care, it weakens it. This policy wasn't based on clinical need, it wasn't based on getting better outcomes, it came from a place of bureaucracy and trying to limit an expenditure on a line item. This is going to have negative downstream effects. We're going to see more hospitalizations, more ER visits, and ultimately a less well veteran and active duty service member population. So what do we do? If you're a provider, I hope you will speak up. Talk to your professional association, call your TRICARE rep. Let them know what this change means for you and your ability to serve patients well and sustainably. If you're a veteran, active duty service member, or a family member, your voice matters. If this policy is affecting your care or the care that someone you love receives, tell that story. Reach out to your elected officials. share what's happening on the ground. And if you're a policymaker, take a fucking look in the mirror. Go visit a mental health practice and see what we are up against. Talk to the people here doing the work. Talk to the patients receiving care and ask whether or not we're making it easier or harder to deliver good care with these new changes. At the end of the day, we don't need any more awareness campaigns. We need action. And the clock is ticking on this one.