A SAD STATE OF CARE: POLICY REFORM OPTIONS PROMOTING EQUITABLE HEALTHCARE ACCESS FOR NATIONAL GUARD SERVICE MEMBERS ON STATE ACTIVE DUTY
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Authors
Keuma, Samantha
Subjects
National Guard
State Active Duty
Healthcare Benefits
Defense Support of Civil Authorities
Homeland Security
Homeland Defense
Civil Support
healthcare benefits
TRICARE
DSCA
workers compensation
T10
T32
SAD
State Active Duty
Healthcare Benefits
Defense Support of Civil Authorities
Homeland Security
Homeland Defense
Civil Support
healthcare benefits
TRICARE
DSCA
workers compensation
T10
T32
SAD
Advisors
Karimi, Bijan P.
Brown, Shannon A.
Date of Issue
2025-03
Date
Publisher
Monterey, CA; Naval Postgraduate School
Language
Abstract
National Guard service members (NGSMs) play a critical role in disaster response, homeland security, and civil support missions, yet they face significant disparities in healthcare benefits when activated under state active duty (SAD) compared to their federally activated counterparts performing the same missions under Title 32 and Title 10. This thesis examines these inequities in healthcare and their broader implications for mission readiness, retention, and NGSM well-being. Through a comparative analysis of current policy frameworks, including TRICARE eligibility, state workers’ compensation systems, and legislative mandates, this research highlights critical gaps in healthcare provisions for NGSMs under SAD. Applying a multi-criteria decision analysis framework, the research explores five policy reform options—expanding TRICARE Reserve Select to cover SAD-status NGSMs, establishing and enforcing a federal minimum healthcare standard for state workers’ compensation programs, providing conditional TRICARE eligibility for SAD-status NGSMs, and extending TRICARE Prime to all NGSMs—to assess their feasibility, affordability, and impact on state autonomy. The findings suggest that conditional TRICARE eligibility for NGSMs under SAD represents the most viable and equitable solution, ensuring comprehensive healthcare while preserving state autonomy and control.
Type
Thesis
Description
Series/Report No
Department
National Security Affairs (CHDS)
Organization
Identifiers
NPS Report Number
Sponsors
Funder
Format
Citation
Distribution Statement
Distribution Statement A. Approved for public release: Distribution is unlimited.
Rights
This publication is a work of the U.S. Government as defined in Title 17, United States Code, Section 101. Copyright protection is not available for this work in the United States.