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Sunday, December 12, 2010

Idaho Cuts Services for Adults on the Spectrum

The Magic Valley [Idaho] Times-News reports on autistic Idaho adults having to choose between services because of Medicaid cuts:

Eric currently receives two types of service through Medicaid: psychosocial rehabilitation and developmental therapy. Developmental technicians like Voss help clients with life skills, like balancing checkbooks and housecleaning, plus physical issues, like coordination and how to handle sensory overload. As part of DT, Eric volunteers at Parke View Care and Rehabilitation, which helps him socialize and gives him responsibilities outside of the home.

Psychosocial rehabilitation, or PSR, workers help clients with social skills and address emotional issues, like dealing with frustration and anger. As Eric explained, “fitting in more with society.”

Eric meets with his developmental technician for 10 hours every week and his PSR worker five hours per week.

For DT, Health andWelfare spokeswoman Emily Simnitt said, Medicaid reimburses providers at about $20 per hour, although rates depend on whether therapy is individual or in a group. Medicaid reimburses providers $45.40 for an hour of PSR.

Temporary rules, designed to help Medicaid reduce costs, force Eric to choose between the two services. The rules are set to expire in July, the end of the 2011 fiscal year, although the cuts might be extended this legislative session.


Not everyone agrees that both services are necessary — including some service providers themselves.

The Idaho Legislature directed the Idaho Division of Medicaid to consult Medicaid service providers about where to find savings, Wilkinson said. In a survey, many respondents were critical of PSR and DT services, calling the program inefficient and suggesting more oversight.

“Someone who has been on Psycho-social Rehabilitation for 10 years with the same goals should be closed to Psycho-social Rehabilitation,” one anonymous survey respondent wrote. “Goals should be realistic, time specific and re-evaluated and considered before continuing to authorize the service with unlimited hours where a Psycho-social Rehabilitation worker just hangs out with them as their friend.”

Other criticisms: Developmental technicians are undereducated, service agencies profit too much, and PSR and DT services overlap. Some providers questioned how much adult clients benefit from the services, calling the two glorified day care. “(Developmental therapy) is a waste of money because by that time they’ve either learned what they need to or not,” one Medicaid provider wrote. “If not, they are not likely to.”

That’s not the case, insist Eric Forth and his family. Since getting both PSR and DT services about three years ago, Eric’s behavior has improved, Mike Forth said. Eric gave an example of a recent encounter while volunteering with a woman who had brain damage. When Eric pointed out she was breaking the rules of the game they were playing, the woman began cursing at him. He spoke to her calmly and knew not to take the incident personally, Eric said.

If that had happened three years ago, “I probably would have hit her,” he said.