Kids With Autism Lose Access to Services Amid Healthy Families Shift
A children's health advocate says that an unknown number of autistic children who have transitioned from Healthy Families to Medi-Cal no longer have access to applied behavioral analysis therapy, the Sacramento Business Journal reports.
Healthy Families is California's Children's Health Insurance Plan, and Medi-Cal is California's Medicaid program (Robertson, Sacramento Business Journal, 4/9).
Background on Healthy Families Shift
In October 2012, Diana Dooley -- secretary of the state Health and Human Services Agency -- said that the state will shift about 863,000 children from Healthy Families to Medi-Cal, which reimburses physicians at lower rates.
Dooley said that the transition will help streamline and simplify government health care programs for California children (California Healthline, 12/5/12).
About ABA Therapy
In 2011, Gov. Jerry Brown (D) signed a law (SB 946) that requires all health plans as of July 1, 2012, to cover applied behavior analysis, or behavioral intervention therapy, for individuals with autism or similar illnesses. The therapy typically consists of intensive sessions with a therapist who uses conditioning techniques to help influence behavior.
Many insurers had previously denied coverage for the therapy, arguing that it is not a medical service and that health plans are not required to cover it by law (California Healthline, 2/28).
Norman Williams -- deputy director of the California Department of Health Care Services -- said that SB 946 exempts Medi-Cal from the requirement to cover ABA therapy.
Karen Fessel -- executive director of the advocacy group Autism Health Insurance Project -- said that letters to families with autistic children moving from Healthy Families to Medi-Cal have pledged that no one will lose coverage, but several families have had coverage for ABA therapy discontinued.
Fessel said that state officials discussed the matter at a Senate budget subcommittee hearing last week but that whether Medi-Cal will begin covering the therapy remains unclear.
Williams said that Medi-Cal offers children with autism "medically necessary" services that could include occupational, speech and physical therapy. Some children might quality for specialty services -- including ABA -- based on their diagnosis, he said.Williams added, "However, we are still assessing the specific availability of ABA services" (Sacramento Business Journal, 4/9). This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.