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Monday, July 8, 2013

More on Medi-Cal

At The Los Angeles Times, Chris Megerian reports on an Evan Kim, a child with autism:
Evan's therapy was a casualty of the state's effort to phase out its Healthy Families insurance program and shift the nearly 900,000 children it covered into Medi-Cal, the broader healthcare program for the poor. Despite officials' assurances that the transition would not jeopardize services, activists say hundreds of children are losing coverage for applied behavior analysis.
"Those are the families that fall through the cracks," said Julie Kornack, a public policy analyst at the Los Angeles-based Center for Autism and Related Disorders. "If they don't get the treatment they need, they won't be contributing members of society. And everyone will have to pay to take care of them."
Activists fear that other coverage gaps could surface as the state prepares to move the final 150,000 children into Medi-Cal in the next two months. Elizabeth Abbott, an official at the advocacy group Health Access, said she worried that dental resources could also become strained.
"This is potentially the tip of the iceberg," Abbot said.
Rene Mollow, a deputy director at the California Department of Health Care Services, said the transition has been mostly smooth. She said some children can get similar autism therapy through a federal program or local school district, but she conceded that those services won't be available to everyone.
Mollow's statement is not quite accurate. California's Office of Administrative Hearings has explained:
A school district is not required to address a student’s behavior problems that occur outside of
school when the student demonstrates educational progress in the classroom. (San Rafael
Elem. Sch. Dist. v. Cal. Special Educ. Hearing Office, supra, 482 F.Supp. at p. 1160.) A
school district is required to address behavioral problems extraneous to the academic setting
only to the extent they affect the student’s educational progress. (Id. at p. 1162.)
The Times article continues:
Applied behavior analysis is an intensive treatment in which therapists use positive reinforcement to improve a child's behavior and detailed instructions to make learning new tasks easier. It is used to teach a child, among other things, how to get dressed in the morning and play well with others.
Brown expressed skepticism of the therapy when he signed a 2011 bill requiring many private insurers — but not Medi-Cal — to cover applied behavior analysis.
"There are remaining questions about effectiveness, duration and the cost of the covered treatments that must be sorted out," he said in a statement.
Autism experts disagree, saying the therapy can be costly but is vital.
"They're taking away the only scientifically proven treatment for children who have a very significant medical condition," said Jonathan Tarbox, director of research and development at the Center for Autism and Related Disorders. The center provides applied behavior analysis through state-funded programs.