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Wednesday, October 30, 2013

Some "Bumps" in California

California Healthline reports:
Toby Douglas, director of the state's Department of Health Care Services, called the withdrawal of autism services "some bumps" in the transition of Healthy Families children to Medi-Cal managed care.
Autism advocates begged to differ, characterizing it as a disaster in the lives of many families with autistic children because kids who received applied behavior analysis -- known as ABA therapy -- under Healthy Families stopped receiving it in the Medi-Cal system.

At an Assembly oversight hearing last week, Douglas said this year's Healthy Families transition, which goes into its final transitional phase this Friday, has gone better than state health officials expected.
Quynh Kieu, a pediatrician practicing in Fountain Valley, said Douglas' assessment of the Healthy Families transition was accurate in some respects.
"Coverage has been fairly good and most children have been able to keep their primary care provider," Kieu said. But her agreement ended when it came to autism care.

"For children who need ABA therapy or speech therapy, it has been nearly impossible," she said. "It's been a real hurdle to obtain the care for them."
Also in California Healthline:
Families dealing with autism often have to cobble together more than one form of health insurance to make sure treatment is covered. Regulations governing exchanges stipulate that if a family member has affordable coverage provided by an employer, dependents are not eligible for federal subsidies on the exchange.
Although policies sold in Covered California must include autism coverage, employer-funded plans are not required to include it. Families can purchase coverage through the exchange for full price, but because autism treatment is often expensive, advocates point out that low-income families need subsidies, especially those receiving a specific kind of expensive, intensive treatment -- applied behavioral analysis, known as ABA therapy.
"Speech therapy and occupational therapy are the most common forms of treatment and they are often covered by insurance, but ABA is considered the gold standard of therapy for autism and it's very expensive," said Cecily Ruttenberg, communications director for Autism Health Insurance Project.
"It was a big deal when the ACA was being put together as to whether ABA was to be included as an essential benefit. Then when it was decided that each state would decide its own essential benefits, we were thrilled that California was one of 24 states that included it," Ruttenberg said.
"But there are still a significant number of families who are not going to be able to afford ABA in California because of some of the rules in place and because Medi-Cal does not cover it," Ruttenberg said.
Autism advocates are lobbying to get ABA therapy covered by Medicaid nationally and by Medi-Cal in California. They're also working to change the regulation barring subsidies in families with employer-provided coverage