Sacramento, CA (PRWEB) September 12, 2014
As many as 75,000 primarily low-income California children with autism spectrum disorder (ASD) will become eligible for a life-altering form of treatment through Medi-Cal starting Monday September 15th, when California becomes the first state to implement a federal directive to step up Medicaid coverage for children with autism. Up to 12,000 of these children are expected to utilize the new benefits, according to a coalition of California and national advocacy groups. They have joined with Senate President pro Tem Darrell Steinberg in praising the states move.
Through this decision we have achieved and cemented the original vision of SB-946, which is full coverage under both private and public health plans for behavioral health treatment, Steinberg said, referring to the autism insurance reform law he authored in 2011. This important milestone will ensure that all children in California, regardless of their insurance or economic status, will have access to life-changing treatments for autism spectrum disorders.
On Monday, the state Department of Health Care Services (DHCS) will issue an All-Plan Letter to Californias Medi-Cal managed care plans directing them to start covering behavioral health treatment, such as applied behavior analysis (ABA), for individuals with autism up to age 21. Medi-Cal insures more than 5 million children, approximately half of the children in California. Until now, autism treatment has not been available to low-income Californians with ASD who are Medi-Cal beneficiaries.
While 75,000 children could be eligible, experience in California and other states has shown about 1 in 6 will ultimately utilize behavioral health treatment based on medical necessity and other factors. Approximately 4,000 to 6,000 of the affected children currently receive no treatment, including children who lost these critical services last year in the Healthy Families to Medi-Cal transition. Another 6,000 to 7,000 of the affected children now receive behavioral health treatment through the Regional Centers; that will continue until a transition plan is developed for transfer into Medi-Cal plans.
This is a landmark moment for Californias autism community and positions the state as a national leader in delivering meaningful coverage to treat autism, the fastest growing developmental disability in the United States, said Dan Unumb, executive director of the Autism Speaks Legal Resource Center. Behavioral health treatment can dramatically improve the lives of many people with autism, enabling them to mainstream into our schools and society while reducing taxpayer costs for special education and longterm support services. This is a huge step in our ongoing efforts to ensure that all families across the country have access to essential healthcare.
After years of having to inform children and families on Medi-Cal who desperately needed treatment for autism that the state had no help for them, its incredible to be able to tell families we can help connect them to this life-altering treatment, right away, said Kristin Jacobson, president of Autism Deserves Equal Coverage. We commend the California Department of Health Care Services for moving quickly to ensure that all California children get the behavioral health therapy they are entitled to, thereby making a difference in the lives of thousands of vulnerable California families.
Maria Cruz of Los Angeles has a 9-year-old daughter, Shirley, who was diagnosed with autism when she was 7. Because Medi-Cal has yet to provide behavioral health treatment for autism, Shirley not only was diagnosed very late, but also has never had any treatment for her autism. She was turned down for treatment by the Regional Center and school district and has had nowhere else to turn.
I am delighted that my daughter will be able to get the treatment she so desperately needs, Cruz said. Everywhere I have gone so far the door has been shut in my face. Now our lives can get better.
In April, Maria traveled 14 hours round trip by bus from Los Angeles to Sacramento for the autism awareness rally to ask legislators to help her daughter. I asked them please to help my daughter and now they are. I am so happy!
Jazzmon Wilson from the Sacramento area has two children on the autism spectrum. Her youngest son Joshua is now getting ABA from the ALTA Regional Center. When he was 2 years old, her oldest son Timothy received the treatment from the Regional Center of the East Bay where he made great gains. But when Timothy turned 3, he was determined ineligible for further Regional Center services and his ABA was terminated.
Jazzmons insurance, Medi-Cal, did not cover ABA, so for the next three years, Timothy received no treatment. His behavior deteriorated and many of the gains he had made were lost. He has recently secured some ABA from his school district and started making progress again, but that service is ending in mid-October.
I have seen the benefits of ABA, both for Timothy and Joshua, said Wilson. I cant let what happened to Timothy happen to Joshua. I lost services once for Timothy and it took me almost three years to get them back. He cant lose them again.
Our family wouldnt survive, Wilson said. I am so relieved that I will be able to get treatment from Medi-Cal for Timothy and Joshua. I can sleep again at night.
Background: Autism spectrum disorders are a group of complex disorders of brain development characterized, in varying degrees, by difficulties in social interaction, verbal and nonverbal communication and repetitive behaviors. The prevalence of autism has skyrocketed tenfold over the past 40 years and now affects an estimated 3 million Americans. According to the Centers of Disease Control and Prevention, 1 in 68 American children have autism, including 1 in 42 boys and 1 in 189 girls.
Behavioral health treatment has been demonstrated to improve functioning of people with autism. Studies of ABA have shown nearly half of children who receive early intensive treatment can transition into mainstream classrooms with their typically developing peers. However, treatment costs can reach $ 70,000 a year, putting it out of the financial reach of most families without some insurance coverage.
California is one of 37 states requiring state-regulated health plans to cover behavioral health treatment for autism. In addition, health plans sold through Covered California, the states health insurance marketplace, are required to cover the treatment.
Many employer health plans are self-funded and regulated by federal law which does not require autism coverage. However, many California-based employers, such as Apple, Cisco, EBAY, Facebook, Google, Intel, Oracle, PG&E, Qualcomm, Yahoo! and Wells Fargo voluntarily offer the benefit. In addition, the denial of autism benefits through self-funded plans is eroding through class action litigation challenging the prohibitions as a violation of federal and state Mental Health Parity laws.
Autism insurance coverage has become a high priority for an unprecedented number of autism advocacy, childrens advocacy, legal aid, and health advocacy organizations who have worked together to advocate for coverage. The following organizations hail the states action on establishing this new autism benefit.