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Friday, April 8, 2011

Autism, Minnesota, and The Matthew Effect

"Whoever has will be given more, and he will have an abundance. Whoever does not have, even what he has will be taken from him." (Matthew 3:12, NIV).

This passage from the New Testament sums up the experience of ASD people receiving government services, whether from schools (as Colin Ong-Dean documents) or from other agencies. Families with money, education, and connections can work the system to get more. Those without these resources -- even though their needs may be greater -- often get less.

Maura Lerner writes at The Minneapolis Star-Tribune:

Rep. Jim Abeler, R-Anoka, introduced legislation Wednesday calling on the commissioner of human services to review a policy that critics have called a double standard.

The Star Tribune reported earlier this week that the state Medicaid program has subsidized a costly and intensive autism treatment for some affluent families while denying it to low-income children in its managed-care plans.

The treatment, known as Applied Behavior Analysis, can cost up to $100,000 a year.

"We were told Medicaid doesn't pay [for it]," said Abeler, chair of the House Health and Human Services Finance Committee. "We need to do it equitably, either all or none."

The House voted Thursday to approve health legislation that includes Abeler's amendment, which calls on the state "to extend the same autism treatment benefits" to all children in Medicaid programs.

From the original story:

Two years ago, a single mother in the Twin Cities asked the state Medicaid program to pay for an intensive type of autism therapy for her 2-year-old son.

She was turned down. State officials said the treatment -- known as Applied Behavior Analysis, or ABA -- is "not now, and never has been,'' a covered service.

It turns out, though, that's not the whole story.

For years, Minnesota taxpayers have been subsidizing that same treatment, which can cost up to $100,000 a year, for middle-class and even wealthy families, including the children of lawyers and business executives


Since the 1990s, a number of Minnesota families have found a way to get ABA therapy at taxpayer expense, says Dr. Eric Larsson, one of the pioneers of ABA therapy in Minnesota and founder of the Lovaas Institute Midwest, an autism treatment center in Minneapolis.

From the start, he said, they were mostly families with the money and persistence to fight for what they wanted.

They would apply for Medicaid coverage for their children through a special disability program, specifically for families above the poverty level. To get in, the child must be certified as disabled, and parents are required to pay a sliding fee (up to 13.5 percent of income).

Initially, Larsson said, the state rejected most of their requests to pay for ABA therapy -- which can involve up to 40 hours a week of treatment. But on appeal, he said, "every family that could afford an attorney won."

Eventually, it became common knowledge within certain circles that Medicaid would pay for ABA under the billing code for "skills training."

In fact, said Dawson, state officials certified those programs and told them what billing codes to use. "They know they use the ABA method, and they routinely pay those bills."