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Wednesday, February 11, 2015

Medicaid in Connecticut

The Connecticut Post reports that although the state's Medicaid program is expanding coverage, it is also proposing regulatory barriers:
Some provisions of the proposed regulations are unlike those any other state has imposed, according to the national advocacy group Autism Speaks. One requirement – that a caregiver be present or available at all times while treatment is being provided – would discriminate against children of working, single or disabled parents, the group said. And it warned that another provision related to provider qualifications “threatens to virtually gut coverage in Connecticut and deprive Medicaid-eligible children under 21 of medically necessary care in direct violation” of federal obligations.
“There are so many roadblocks here that it’s unlikely for this to allow for the demand to be met,” said Jay Sicklick, deputy director of the Center for Children’s Advocacy, which is affiliated with the UConn School of Law.
In the past, the state Department of Social Services denied Medicaid coverage of applied behavior analysis to families seeking it for their children. But last summer, the federal government made clear that state Medicaid programs must cover medically necessary services for clients under 21 with autism spectrum disorders.At issue is how Medicaid will handle coverage of services for autism spectrum disorders, particularly applied behavior analysis, a treatment that is considered effective but is also intensive – providers often recommend 30 to 40 hours of therapy per week – and costly.
DSS has projected that the coverage would cost $28.1 million in the next fiscal year, half of which would be reimbursed by the federal government. Although the regulations are not finalized, the coverage took effect Jan.1.