Department of Health Care Services director Toby Douglas testified yesterday that some Healthy Families participants will probably lose a type of autism service in the transition to Medi-Cal managed care plans.
The service — applied behavioral analysis — is still covered by Medi-Cal, Douglas said, but in a different way. Families with an autistic child will need to reapply for the service through the state’s regional centers, where eligibility criteria are stiffer. Some children who qualified in Healthy Families may not be eligible under new guidelines, officials said.
Douglas testified yesterday before the Assembly Budget Subcommittee on Health and Human Services. His disclosure rubbed a number of legislators the wrong way.
“I feel a little like a hamster on a wheel,” said committee chair Holly Mitchell (D-Los Angeles). “When the budget document was in front of us before, we asked just these questions. If this goes through, what happens? We saw this train coming. For us to go through elimination of the [Healthy Families] department, and now to have story after story from people who aren’t getting servicesâ¦.” Mitchell raised her palms up in frustration.
Douglas said he never promised that Healthy Families recipients would keep all of their Healthy Families services.
“We did talk about changes that would occur,” Douglas said. “We did not say that nothing in their benefits would change.”
Douglas said applied behavioral analysis for autism patients will still be a Medi-Cal benefit, just not a Medi-Cal managed care benefit.
“Yes, things have changed with ABA services, it is no longer a benefit of Medi-Cal managed care, [but] it’s a benefit through the regional centers.”
According to Kristin Jacobson, co-founder and president of Autism Deserves Equal Coverage, regional centers have much more stringent eligibility qualifications and about 75% of the autism families in Healthy Families don’t qualify for ABA at the regional centers.
The state has contracted with 21 private not-for-profit regional centers that will provide or coordinate services for Medicaid beneficiaries with developmental disabilities, including autism.
“It’s going to be devastating to families to not have this therapy,” Jacobson said. “Regional centers don’t cover all kids on the autistic spectrum, so it’s not a solution for 75% of the autism population.”
“I can’t say there arenât consequences,” Douglas said, “since it’s a benefit that isn’t provided by health plans, and it was provided in Healthy Families.”
Douglas was pressed by Assembly member Allan Mansoor (R-Costa Mesa), who had a written statement from DHCS to beneficiaries that said benefits would remain intact.
“Does that statement not apply to ABA services? Is that statement true?” Mansoor asked.
“The statement is true,” Douglas said. “What isn’t reflected is, it’s still a benefit within Medi-Cal, but you may not qualify [for it].”