Medical Clearance Modernization As part of the State Department’s modernization initiative, the medical clearance process was substantially reformed in 2024. For decades, the Bureau of Medical Services (MED) determined where you could not be assigned if you or one of your family members did not have a Class 1 clearance (cleared for worldwide service). MED would determine whether a medical condition could be successfully managed at a particular post, and then the employee or the family member would receive a post-specific Class 2 clearance (e.g., “Class 2, cleared for Ruritania”). Parents of children with special educational needs faced another hurdle. Those parents had to get a provisional acceptance letter from a school at post before MED would issue the child a Class 2 clearance and the employee could be paneled to their assignment. AFSA advocated for years against this practice, arguing that it inappropriately conflated educational and medical issues, and the department should not be acting in loco parentis, because parents could be trusted to do what was best for their children. In 2024, MED adopted an entirely new philosophy toward clearances, which was reflected in dramatic changes to the process. MED has now taken the position that its role is to help employees and their family members manage their care wherever they choose to go, not to dictate where they can be assigned. These changes were outlined in three cables: 24 State 39412, 24 State 41964, and 24 State 55578. All are available in the SMART archives, and AFSA recommends members read them. Reflecting this change, the old clearance terminology is being updated and will be implemented starting January 2025. Individuals will receive a clearance using the new terminology when they update their clearance. In 24 State 39412, MED explained that with the evoluClass 1 Worldwide available Class 2 Post-specific Class 5 Domestic only Class 7 Pending OLD TERMINOLOGY O Overseas eligible OZ Overseas eligible, enrolled in MED Care Management D Domestic only R In review NEW TERMINOLOGY tion and advancements in the global healthcare industry, the new clearance process would “engage the employee in a collaborative dialogue regarding their health needs in the context of potential posts of assignment in which they are interested” to help employees make informed decisions about their bidding priorities and take ownership of their health care needs. For example, if someone with asthma wanted to bid on a post with bad air pollution, MED would have a conversation with that person about what would be involved in managing their care at that post, but the ultimate decision on whether to bid would be the employee’s. That person would receive an “OZ” clearance. MED did reserve the right not to issue a clearance if an individual seemed “unable or unwilling” to take on responsibility for their care needs that weren’t available at post, or if MED determined there was a “substantial risk of harm.” 24 State 41964 clarified that the same consultation process will apply to mental health as well, and that the mental health review period has been reduced from seven years to two. 24 State 55578 announced that children with special educational needs no longer needed to be provisionally accepted to a school before they could receive a MED clearance. Instead, the parents of children with identified special educational needs would be required to engage in a mandatory consultation process with MED’s Child and Family Program (CFP), one meeting per clearance review period (per PCS). MED will no longer deny a medical clearance to a child with special educational needs on the basis that the child has not been provisionally accepted to a school, and the medical clearance will be adjudicated only on the basis of medical needs. After the mandatory consultation, it will be the parents’ choice whether to stay involved with MED regarding their child’s needs. It’s important to note that the medical clearance process for children with special educational needs is separate from the Special Needs Education Allowance (SNEA) approval process, which is detailed in 3 FAM 3280. THE FOREIGN SERVICE JOURNAL | OCTOBER 2024 59 AFSA NEWS Continued on next page
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