Medi-Cal Autism Care May Be Lacking

Children with autism spectrum disorder who are in Medi-Cal managed care plans are not getting the care they need, according to children’s health advocates.

A specific autism therapy — applied behavior analysis, known as ABA therapy — became a Medi-Cal benefit in September 2014. But according to figures released last month by the Department of Health Care Services, as of May 5, fewer than 1,123 children have received behavioral health treatment services, which include ABA therapy.

An estimated 76,000 children under age 21 in the Medi-Cal program have autism spectrum disorder.

“That’s well under 2%,” said Karen Fessel, executive director of the Autism Health Insurance Project. “It’s frustrating that it’s taking so long. Many [managed care plans] are not building a good faith network. Some have but most have not.”

According to state statistics:

  • 24 of California’s 58 counties have provided no behavioral health treatment under Medi-Cal managed care plans;
  • 18 counties have fewer than 11 cases per county (an exact number can’t be released due to privacy issues); and
  • The remaining 16 counties provide BHT services to 943 Medi-Cal managed care children, an average of roughly 59 children per county.

Part of the issue, Fessel said, is that DHCS has not yet set provider rates, so it may be more difficult for managed care insurers to establish a network of providers of autism therapy services.

Norman Williams, deputy director of public affairs for DHCS, gave California Healthline an updated estimate on Wednesday.

“Between 1,500 and 2,000 Medi-Cal managed care members are currently receiving BHT (behavioral health treatment) services, and we expect to have updated numbers soon,” Williams said in an email message. 

It’s important to understand the state already has a network of behavioral health care in its regional centers, Williams said, that serves about 9,000 people and includes some ABA therapy patients.

Medi-Cal managed care plans are about to take on those regional centers’ BHT services, he said.

“Medi-Cal managed care responsibility for BHT services for the majority of these members will occur later this year,” Williams said. “The number of individuals accessing BHT services seem in line with other states based upon our discussions with them.”

The state has been held up in some of its autism Medi-Cal benefit implementation while it waits for federal approval of the state plan amendment.

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