Medical Assistance Changes Looming for Children Who Have Autism

May 21st, 2012

The Autism Advocacy & Law Center, LLC (AALC) sponsored a “Listening Session” with Deputy Assistant Commissioner of Mental Health Reggie Wagner from the Minnesota Department of Human Services on Saturday, May 19, 2012. The meeting came about because so many families are concerned about whether Medical Assistance (MA) will continue to cover the intensive behavior treatment that is helping their children who have autism. During the past year, children who are receiving intensive early behavior intervention treatment (IEIBT) have endured coverage decisions that have reduced or denied coverage for this medically necessary care. With aggressive advocacy, many of these decisions have been reversed — but the trend is very worrisome indeed to families. As more and more families contacted DHS to express their concerns about coverage for IEIBT, it was decided to hold one large meeting to provide parents with the opportunity to talk directly with Deputy Assistant Commissioner Wagner.

Wagner explained that DHS will be requesting federal permission to change how Minnesota’s MA program is administered. One of those changes will be a request to run a “demonstration project” that will include treatment for autism. What does this mean exactly? DHS will not share the details yet, but it seems apparent that access to some types of treatment and services will be restricted to individuals who are lucky enough to participate in the demonstration project. For example, if a child requires more than 15 hours a week of behavior therapy, that child may not have coverage for the therapy unless he is included in the demonstration project.

After listening to Deputy Assistant Commissioner of Mental Health Reggie Wagner on Saturday morning, the AALC is now more concerned then ever that DHS will purposefully cause an interruption in treatment to hundreds of children who have autism as part of this “reform” process. DHS maintains that it is not their intention to reduce services to kids who have autism. Officials at DHS espouse the MA reform efforts as focused on improving the quality of services that children who have autism are receiving. With regard to whether or not some children will lose coverage for evidence-based, medically necessary care during this transition period, officials refuse to say. They do admit, however, that there may be a “transition period” while the demonstration project is used to collect data that the Department will use to redesign services and supports for individuals who have autism.

Presumably, the adverse consequences to children who have autism will not be revealed until DHS releases its proposal to the federal Centers for Medicaid Services (CMS). That is expected to occur in late June. As soon as DHS releases its “Request for Comments,” the AALC will post a link on its Web site and help to facilitate comments.

It is imperative that the autism community fight to ensure that children do not endure interruptions or reductions on coverage of intensive early intervention behavior therapy. Children who receive IEIBT have a 48% chance of achieving “best outcomes.” This means that 48% of children who receive IEIBT will attain a typical IQ, will no longer need supports or services in regular mainstream education, and no longer meet the diagnostic criteria for autism. Another 40% will improve functional skills and reduce challenging behaviors — such as aggressive behaviors and self-injurious behaviors. For the children who respond well to IEIBT, an interruption or reduction in treatment can alter their prognosis. It could mean the difference between enabling a family to keep their child at home or not being able to care for their own child at home. It could mean the difference between a child achieving independence (“best outcomes”) and needing specialized supports and services her entire life.

The AALC will keep you posted. Sign up for our RSS feed as well as Action Alerts to receive immediate notice when DHS releases its proposal for a demonstration project.



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