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Friday, December 4, 2015

Waiting for Medi-Cal

In The Politics of Autism, I discuss state Medicaid services for people with intellectual and developmental disabilities.

David Gorn writes at California Healthline:
State health officials' proposals for autism therapy in Medi-Cal -- a relatively new benefit -- have ticked off many in the children's advocacy world.
Autism therapy was ruled in September 2014 to be a Medi-Cal benefit, but getting that care to children has been a huge hassle, advocates said -- and it promises to be more difficult if the draft letter to health plans becomes policy, they said.
"There are definitely some kids getting treatment now who weren't getting care [a year ago]. But there has been an unacceptably slow implementation for the majority of Medi-Cal beneficiaries who still need the care," said Kristin Jacobson, executive director of Autism Deserves Equal Coverage, a children's advocacy group based in Burlingame.
Only a tiny fraction of the estimated 75,000 Medi-Cal children with autism are getting treatment for it, Jacobson said.
The central complaint has been a lengthy diagnostic assessment that the state requires for every Medi-Cal beneficiary of autism therapy, even if a child has already been diagnosed. Getting that assessment has resulted in long waiting lists -- up to six or nine months in some cases -- for families trying to access care, advocates said. Because the state is bound by statute to provide care within 10 to 15 days of initial diagnosis, that lengthy wait violates federal law;
According to written responses from Norman Williams, DHCS spokesperson, the state's requirement for a comprehensive diagnostic evaluation will benefit Medi-Cal children by ensuring proper care and resulting in better outcomes.
"The primary purpose of a diagnosis is to provide guidance for intervention/treatment," the statement said. "Accurate diagnoses lead to appropriate treatment, which leads to enhanced outcomes. Accurate diagnoses, patient safety and appropriateness of treatment services are the compelling reasons for a comprehensive diagnostic evaluation."