Indiana Medicaid Cuts

The Politics of Autism includes an extensive discussion of insurance and Medicaid services.

Isabella Volmert at AP:

Indiana’s Family and Social Services Administration said the cost of Medicaid reimbursement for the behavioral therapy, commonly referred to as ABA, has ballooned in recent years because of the growing number of children seeking the services and the amount that providers have billed the state. The state plans a universal, hourly reimbursement rate for the therapy, but the planned amount is lower than what providers have previously received on average.

Advocates and centers worry this will mean accepting fewer patients or even closing, as has happened in other states such as Colorado this year.

“Companies just kept leaving and it just kind of turned into a crisis situation,” said J.J. Tomash, who leads an ABA provider in Colorado called BehaviorSpan. He blamed Medicaid reimbursement rates that have not kept up with the cost of living.

Medicaid began covering the services in 2016, and providers in Indiana set their own rates until now. But centers say the new rates are still not enough to keep them running and are far below the previous statewide average of $97 per hour.

Indiana Act for Families, a coalition opposing the new rates, said the proposal is 10% below providers’ operating costs. Although Indiana has said the new rates are aligned with pay in other states, the coalition argued the state used outdated data in their comparison.

...

ABA is not without critics. Zoe Gross, advocacy director at the Autistic Self-Advocacy Network, said ABA’s goal is to eliminate behaviors considered autistic and teaches children to conform with neurotypical behaviors.

“It teaches you that the way you naturally behave is not OK,” she said.

But families who have found it helpful find it hard to imagine a future without access.

Pushback Against Cuts in Indiana

The Politics of Autism includes an extensive discussion of insurance and Medicaid services.

Whitney Downard at Indiana Capital Chronicle:

A bipartisan group of lawmakers from both chambers sent a letter to Gov. Eric Holcomb earlier this week urging him to reconsider the proposed rate cuts for Applied Behavioral Analysis (ABA) therapy, a specialized form of treatment for autistic children.

The letter, authored by Shelbyville Republican Rep. Robb Greene, was signed by 13 senators and 29 representatives from across the state. Greene, a freshman legislator, shared the impact of ABA therapy on his young son. Rep. Robb Greene, R-Shelbyville (Photo from the House Republicans)

“When my son, RG, was diagnosed with (Autism Spectrum Disorder) at age 3, he was functionally non-verbal. At an age when many parents are experiencing the joy that accompanies each milestone, we were told that our son had the developmental parity of a nine-month-old,” Greene wrote in a statement.

“… Within 2 months (of ABA therapy), RG went from very few vocalizations to the start of meaningful exchanges with us, his peers and his therapy team. Within the first year, he acquired many necessary life skills, such as beginning and mastering potty training, efforts made toward dressing himself and learning coping mechanisms that enabled our family to socialize together in more public settings,” Greene continued.

Greene said RG’s current ability to communicate basic needs and advocate for himself wouldn’t have occurred without “intensive” ABA therapy. His son now attends kindergarten at the family’s local public school.

“Simply put, ABA saved my son’s life,” Greene said.

Proposed IN Medicaid Limits

The Politics of Autism includes an extensive discussion of insurance and Medicaid services for adults with intellectual and developmental disabilities.

Shari Rudavsky and Kayla Dwyer, Indianapolis Star

 To contain costs, the Families and Social Services Administration, which oversees Medicaid, is proposing standardizing rates for the therapy at a level that many providers worry could threaten their ability to continue providing these services. FSSA disputes this, saying the rate they came up with is based on providers' own cost data. That's true, but FSSA is proposing rates at the low end of a wide scale.

Currently, the hourly reimbursement providers receive from the state varies from $46 an hour to five times that. The average is $91 an hour.

Now the state is proposing instituting a flat rate of $55 an hour for the most common form of therapy ― meaning, in comparison to what the providers have been accustomed to receiving, a small handful of providers would get a bump, but most would experience a dramatic decrease.

Providers, too, agree that there needs to be a standardized rate. But choosing $55, as FSSA is proposing, goes too far, too quickly, they argue.

"I definitely think there’s some middle ground, but what we're experiencing now, if these in-center ABA therapy centers are to close, they (the children) are going to be pushed into the school system that’s already overwhelmed," said Hillori Wanninger, a board certified behavior analyst with Shine Pediatric Therapy. "This is a very rippling effect."

"Disturbing Reports" -- OCR Probes Pandemic Special Ed in WA and IN

 In The Politics of Autism, I discuss the day-to-day challenges facing autistic people and their families. Those challenges get far more intense during disasters.  And coronavirus is proving to be the biggest disaster of all. Providing education is proving to be very difficult.

 Hannah Furfaro  and Dahlia Bazzaz report at  the Seattle Times:

The U.S. Department of Education’s Office for Civil Rights is investigating Seattle Public Schools after hearing “disturbing reports” about how the district handled special education during the pandemic.

In a letter sent Tuesday to Superintendent Denise Juneau, department officials cite concerns that some students with disabilities went without specialized instruction — and some teachers weren’t allowed to provide it.

“According to one local news report last spring, the District told its special education teachers ‘not to deliver specially designed instruction,’ and disallowed them from ‘adapt[ing] lessons to each child’s needs,’” wrote Kimberly M. Richey, the Education Department’s acting assistant secretary for civil rights. “OCR [Office of Civil Rights] is concerned that the District has failed to provide a ‘free appropriate public education’ to each qualified student with a disability as required by federal law and denied students with disabilities equal access to education.”

The U.S. Department of Education’s Office for Civil Rights is investigating Seattle Public Schools after hearing “disturbing reports” about how the district handled special education during the pandemic.

In a letter sent Tuesday to Superintendent Denise Juneau, department officials cite concerns that some students with disabilities went without specialized instruction — and some teachers weren’t allowed to provide it.

“According to one local news report last spring, the District told its special education teachers ‘not to deliver specially designed instruction,’ and disallowed them from ‘adapt[ing] lessons to each child’s needs,’” wrote Kimberly M. Richey, the Education Department’s acting assistant secretary for civil rights. “OCR [Office of Civil Rights] is concerned that the District has failed to provide a ‘free appropriate public education’ to each qualified student with a disability as required by federal law and denied students with disabilities equal access to education.”

Arika Herron at the Indianapolis Star:

 The U.S. Department of Education’s Office of Civil Rights is investigating the Indiana Department of Education over what it called, in a letter sent Tuesday to Education Secretary Katie Jenner, “disturbing reports” that the state denied students with disabilities equal access to education during the COVID-19 pandemic.

Under federal law, schools are required to provide a "free appropriate public education" to each qualified student with a disability.

In its letter, OCR said it was concerned that Indiana had failed to do so and was “particularly troubled” by reports that parents of disabled students in Indiana schools have filed multiple complaints with IDOE alleging that students were forced by local school districts into “one size fits all” remote learning programs, instead of individualized programs designed to meet the need laid out in their Individualized Education Plans or 504 Plans. Qualifying students with disabilities are guaranteed services, spelled out in their IEP or 504 Plan, to meet their unique needs and ensure they have equal access to a free public education.

Evidence on Vouchers

In The Politics of Autism, I write about special education and the Individuals with Disabilities Education Act.

Christina Samuels writes at Education Week about studies of voucher programs in Indiana and Louisiana. Voucher students showed no academic gains in their early years of enrollment, and sine lost ground. MORE DETAIL HERE.

The Indiana study tracked a selection of students in grades 3-8 who switched from public to private schools using Indiana's Choice Scholarship Program, the country's largest voucher program. ...

[S]pecial education students in the study performed worse than students in the study as a group; they saw academic achievement losses in English/language-arts as well as in math.

The Indiana voucher program requires that parents of children with disabilities and the private school agree on a "Choice Scholarship Education Plan" that has some similarities to the individualized education program that is required under the IDEA. However, IEPs are much more comprehensive and are intended to meet the student's legal right to a free, appropriate public education.

In the Louisiana research, researchers found that students who participated in the Louisiana Scholarship Program had no statistically significant gains in math or English/language arts after participating in the program for three years... 

• About 13 percent of the voucher applicant pool was students was disabilities, roughly equal to the population of students with disabilities in Louisiana as a whole;

• In the second year of participation in the voucher program, students with disabilities were nearly 50 percent more likely than students who did not get a voucher to lose their disability identification;

• The chance of a voucher student being newly identified as having a disability was slightly lower than the control group rate.

Judge Blocks Indiana Abortion Law

In The Politics of Autism, I explain:

When a pregnancy is under way, doctors can detect certain kinds of disorders, but neither amniocentesis nor any other prenatal test can currently tell us whether a fetus will become autistic. Suppose that such a test did exist. “The best case use of a prenatal test at the moment would be if you could say to a parent, your child has got an 80 percent likelihood of autism and so once the baby's born, we would like to keep a close eye on that child in case they need extra support like speech therapy or social skills training or some sort of behavioral approach,” says leading autism scientist Simon Baron-Cohen. But would the “best case use” be the most common? When amniocentesis indicates Down Syndrome, most mothers choose abortion. A study of autism parents in Taiwan found that just over half would abort if a prenatal test indicated that their next child would be autistic. We cannot be sure what the figures would be if such tests were available in the United States, but it seems likely that a large share of autism pregnancies would end in abortion.

At The Huffington Post, Kim Bellware reports on a ruling concerning an Indiana law that would have prevented such abortions.

U.S. District Judge Tanya Walton Pratt on Thursday granted a preliminary injunction sought by Planned Parenthood of Indiana and Kentucky [PPINK] to prevent the regulation from taking effect Friday on the grounds the law was unconstitutional and invaded women’s privacy.

Pratt’s order cited Monday’s major U.S. Supreme Court ruling that struck down restrictions in a Texas abortion law. 

Indiana Gov. Mike Pence (R) in March signed a controversial law that imposed new regulations and restrictions on abortion, including a so-called anti-discrimination clause. Indiana and North Dakota are the only states that have laws banning abortion for issues like genetic abnormality.

...
 Indiana University joined the PPINK lawsuit over a provision of the law that sought to control how fetal tissue was transferred and disposed of. 

The university, which conducts research on conditions like autism and Alzheimer’s using fetal tissue, argued that a professor transferring out of state with their research would be unable to do so without committing a felony under the law. 

An Indiana Abortion Law, Disability, and Autism

Chelsea Schneider, Tony Cook and Shari Rudavsky report at The Indianapolis Star that Indiana Governor Mike Pence has just signed an expansion of the state’s abortion restrictions.

Pence, a social conservative with a long track record of opposing abortion, described the new restrictions as a “comprehensive pro-life measure that affirms the value of all human life.”
...
The measure, House Enrolled Act 1337, would make Indiana only the second state to prohibit a woman from seeking an abortion because her fetus was diagnosed with a disability such as Down syndrome. It also would prohibit abortions when they are sought based on the gender or race of a fetus, and would require the remains of miscarried or aborted fetuses to be interred or cremated.

Last week, Sandhya Somashekhar reported at The Washington Post:

The fetal anomaly provision is particularly troublesome, said Patti Stauffer, vice president of public policy for Planned Parenthood of Indiana and Kentucky. It prohibits a provider from knowingly performing an abortion sought because of “a diagnosis or potential diagnosis of the fetus having Down syndrome or any other disability,” according to the bill digest.

Clinics would need to ask women why they want an abortion. It is unclear, Stauffer said, whether the woman would be compelled to provide an answer. The bill digest says doctors could face “disciplinary sanctions and civil liability for wrongful death” if they knowingly abort a fetus because of the diagnosis of a fetal disability.

Supporters of the fetal disability provision say it is critical to prevent discriminatory selective abortions, especially in light of new tests that can tell with a high degree of certainty if a fetus is at risk of developing Down syndrome or another disorder.

What does any of this have to do with autism?  In The Politics of Autism, I explain:

When a pregnancy is under way, doctors can detect certain kinds of disorders, but neither amniocentesis nor any other prenatal test can currently tell us whether a fetus will become autistic. Suppose that such a test did exist. “The best case use of a prenatal test at the moment would be if you could say to a parent, your child has got an 80 percent likelihood of autism and so once the baby's born, we would like to keep a close eye on that child in case they need extra support like speech therapy or social skills training or some sort of behavioral approach,” says leading autism scientist Simon Baron-Cohen. But would the “best case use” be the most common? When amniocentesis indicates Down Syndrome, most mothers choose abortion. A study of autism parents in Taiwan found that just over half would abort if a prenatal test indicated that their next child would be autistic. We cannot be sure what the figures would be if such tests were available in the United States, but it seems likely that a large share of autism pregnancies would end in abortion.

The politics of the issue would be complicated, to say the least. For decades, the broader disability-rights movement has had an uneasy relationship with the movement to curb abortion. On the one hand, selective abortion angers disability rights activists, with some using terms such as “eugenics” and “genocide.” On the other hand, many of these activists also believe that the right to control one’s own body is a thread that connects disability rights and abortion rights. The growing ranks of identified autistic adults could be as conflicted as their elders in the disability rights movement. But it is also possible that they could change the issue’s political landscape by coming down heavily on one side or the other. Expect pro-life and pro-choice groups to vie for their support.

A College Transition Program

Though we have scant data, it appears that more and more ASD people are going to college. AP is carrying a story from Bloomington's Herald Times.  It describes the College Internship Program.

CIP worldwide is a comprehensive postsecondary support program for young adults on the autism spectrum and with other learning differences, according to the organization’s website. Karen Thomas, program director of CIP Bloomington, said the program offers 24-hour-a-day support as students make the transition into adult life.

Students can pursue degrees at Ivy Tech or Indiana University while receiving support and direction from CIP’s academic support team. CIP’s career department helps students with their resumes and finding an internship. Many of the students start out living in the Smallwood apartments located above the center. Independent living support offered for students in the apartments includes menu planning, grocery shopping, cooking and cleaning, assistance with time management and organization.

“We look at it as a transition program,” Thomas said. “It’s the first time these students have been away from home, and they feel really overwhelmed.”

Insurance Cuts in Indiana

The Indianapolis Business Journal reports:

Indiana boasts one of the highest concentrations of autism-focused therapists and even sports a new magazine, Autism Companion, supported by advertisers and subscribers in Indiana. 

“I didn’t even go out and do any market research at all because the demand was so great,” said Jane Grimes, who, before starting the magazine in 2013, was enrollment director at the Applied Behavior Center for Autism, which is expanding to six locations around the state. 

But now Indiana’s autism therapists say their prospects are cloudier after the state’s largest health insurer, Anthem Blue Cross and Blue Shield, cut payments 40 percent and took a harder line on paying for therapy for school-age children. 

One Indianapolis therapy provider, The Hope Source, nearly closed its doors in March because it couldn’t make payroll, although its finances have since rebounded a bit. Most other therapists have cut staff or services. 

For most autism therapists, the Anthem changes began two years ago, when the Indianapolis-based insurer said children age 7 and older need to receive a chunk of their autism therapy from public schools, as state and federal laws for disabled Americans requires. 

“Anthem cannot duplicate coverage for services that are available through the public school system,” Anthem stated in a May 2012 letter to parents of autistic children. The letter reiterated Anthem’s commitment to provide coverage for autism therapy. It has physicians review therapists’ treatment plan for each patient and, while it might deny some of the proposed terms, rarely issues a complete denial of coverage.

Autism, Insurance, and the Affordable Care Act

Jessica Contrera writes at the Journal and Courier (Lafayette, IN) that the Indiana mandate has limits.  Like other mandates, it does not apply to self-insured plans (e.g., Purdue University).  It also does not apply to companies (e.g., Caterpillar) whose insurer is based out-of-state.

So for parents such as Clay and Danielle Sheese, who work for Caterpillar and Purdue, respectively, there is no chance of getting therapy for an autistic child without buying an additional insurance package.

When the Sheeses purchased an additional insurance plan for Jacob in 2011, they chose one that covered him individually.

Today, such child-only plans no longer exist.

“When it seemed to insurance companies that the Affordable Care Act would pass, they needed to cut costs. One of the ways they did that was to eliminate child-only plans,” said Mary Rosswurm, executive director of Little Star in Lafayette. “Now you have to buy a plan that covers both a child and a parent together.”

Dual-coverage plans are far more expensive than child-only. Rosswurm said some of the insurance plans used at Little Star cost parents up to $900 per month. With their child-only plan, the Sheeses pay just over $300 per month. The price differs for each family based on their insurance plans. Some pay for treatment via co-pays, others have no additional costs once they pay their monthly insurance bill.

For some families whose insurance does not cover autism, buying an additional private plan is out of the question, especially when one parent cares for the child instead of working a paid job.

Such families can apply for insurance provided by the Indiana Comprehensive Health Insurance Association. Essentially, ICHIA is state-provided insurance for people who private insurance companies consider to be “uninsurable.”

But this is where the Affordable Care Act comes into play again. Starting in 2014, insurance companies will no longer be permitted to deny coverage based on pre-existing medical conditions. That means there no longer will be “uninsurable” people, and therefore no longer a need for ICHIA to exist.

The program will end on Dec. 31, or as soon as the federal insurance program laid out in the Affordable Care Act begins.

Indiana Voucher Program

The Indianapolis Star reports on Indiana's voucher program and its effect on one Chakotay Parks, who attends the Independence Academy of Indiana, a small private school that specializes in educating HFA students.

Indiana's voucher program allows parents to receive thousands of dollars that can be applied toward tuition at private schools that participate in the program. The amount of aid is based on the per-pupil funding the state sets for a student who otherwise would attend public school in his or her local district, so it doesn't necessarily cover all of the private school tuition.
...

The Parks family started looking for a new school two years ago for Chakotay, who is somewhere in the middle of the autism spectrum. Socially, he's about two years behind but is learning well.

Three to four months into the search, they found Independence Academy.
"It was number one on our Christmas list," said Parks, whose wife had cancer and died in January.

Parks said he and his wife always figured a special needs school would join the program at some point, and it was his wife who pestered state officials, looking for information.

She called, emailed and showed up at the Statehouse so often that Indiana Department of Education workers remembered to reach out to her family once a special education school applied for the program.

Lisa Roesler, director of Independence Academy, understands the benefit to families such as the Parkses of her school and other so-called niche schools accepting vouchers.

"Different environments work for different students," she said, "and the voucher program provides more possibilities to find a program that more specifically meets your child's needs, whatever those are."

Concern About DSM-5

A number of posts have dealt with upcoming changes in DSM-5. Amanda Gray writes at The South Bend Tribune:

Those proposed changes could have large ramifications for local families, said Joshua Diehl, the University of Notre Dame psychology professor who eventually told Pierce with certainty that Wesley had autism.

"We've seen it coming since a couple of years back," Diehl said of the changes. "We began to see it as more research came out about the autism spectrum."
...

Some experts believe up to 40 percent of those currently considered autistic will be affected and might lose their diagnoses, which could affect insurance coverage and other services, according to The Associated Press.

Diehl said many of those diagnosed with specific types of autism would lose specialized services and environments they depend on.

"A lot of people embraced the Asperger's diagnosis culture," Diehl said. "They came out of it as bigger than the diagnosis itself. Autism carries a little more of a stigma with it -- Asperger's is a less stigmatizing diagnosis."

Another potential problem with the proposed changes is the damage they could do to the reputation of the psychology field as a whole, according to Diehl.

"In some ways, there is a danger to undermining the psychology profession," he said. "A lot of families have been struggling for years to find a diagnosis."

Understandably, the definitions needed to be upgraded, according to Diehl.

"The idea is that we created the autism spectrum, and we have a catch-all category (PDD-NOS) that wasn't exactly autism," he said. "Too many people were put in there -- it sort of became autism.

ASD Adults

Shari Rudavsky writes at The Indianapolis Star:

The Autistic Self Advocacy Network, formed five years ago, argues that society should be more accommodating and accepting of those who have autism. Rather than making autistic children "normal," treatment and services should ensure that they have equal opportunities.

Giving those who have autism a voice in the debate is critical, said Ari Ne'eman, the group's president and a founder. Discussing treatment and research priorities without listening to those with autism would be like allowing men to run the women's rights movement, he said.

"Frankly the national conversation in this country has been dominated by parents and professionals," Ne'eman said. "They have a valuable voice, but it's not the only voice out there."

Less than 1 percent of research funds go to support services for the needs of adults with autism, he said.

But increasingly, advocates and even researchers argue that those with autism have skills that others lack. In an article that appeared last week in the scientific journal Nature, a Canadian researcher suggests that many people with autism have unique intelligence. The researcher, who has several colleagues with the condition, has shown that people with autism may have superior cognitive skills, particularly perception and reasoning.

...

Not surprisingly, self-advocates tend to be those on the higher-functioning end. Ne'eman, for instance, serves on the National Council on Disability, a federal agency that advises Congress and the president on disability policy.

Those who are not as high-functioning may need more than the accommodation that the self-advocacy movement supports, said Cathy Pratt, director of the Indiana Resource Center for Autism in Bloomington.

If you view these positions as two distinct camps, "the reality is that sometimes you have to go in between," Pratt said.

But she knows how detrimental the idea of a cure can be. Recently she spent an hour in her office, talking to a man who felt that he would never be accepted unless his autism was cured.

"If their autism is part of their character, part of how they identify themselves, to say to them that we have to cure you now is really saying that we don't accept who they are now," she said.

Waiting in Indiana

The Herald-Bulletin (St. Anderson, IN) reports:

Indiana families of children with autism are facing years-long wait for access to state services, a wide geographic disparity in care, and shrinking resources for those children when they become adults.

That grim assessment was offered Monday to the Indiana Commission on Autism, a legislative study group charged with making recommendations for how to improve care and services for more than 40,000 Hoosiers who have been diagnosed the disorder.

“Our need for services far outstrips the resources that we’ve devoted to this as a state,” said John Dickerson, executive director of The Arc of Indiana advocacy group.

Most pressing may the long wait for access to the state’s Medicaid-waiver programs, designed to keep people with disabilities from being institutionalized. There are now more than 19,000 people on the Medicaid-waivers list, waiting an average of 10 to 12 years to access federal Medicaid funds to help them offset the cost of in-home or community-based care.

More than 5,500 people on the list are individuals diagnosed with autism.

More on First Responders

The Boston Globe reports on a program for first responders:

Westwood Fire Captain Bill Cannata has spent the last six years teaching first-responder firefighters how to recognize the symptoms of autism at an emergency scene so they know how to best approach someone with the disorder who is in distress.

The first-of-its-kind program, which has reached 17,000 professionals in all corners of New England, will now expand to 13 other states, including Oklahoma and West Virginia, with the help of a $52,780 federal Assistance to Firefighters grant from the Department of Homeland Security.

Cannata helped launch the Autism and Law Enforcement Education Coalition in 2005 as a collaboration with the Norfolk district attorney’s office and the South Norfolk County ARC’s Family Autism Center. Startup funding came from the Dedham Institution for Savings.

Today the program is funded through the Autism Spectrum Division of the state Department of Mental Retardation, to the tune of some $35,000 a year, augmented by various small grants. The new federal grant will allow Cannata and his business partner and the center’s director, Betsy Roche, to go national.

Also see a story from Indiana.

Medicaid Waiver Cut

The Bloomington Alternative has a story about Medicaid waiver cut in Indiana. The peg is the plight of Ron Habney a 25-year-old man with autism. He has been getting services through Options for Better Living, a Bloomington nonprofit. Options employee John Willman has been accompanying Habney on his hikes -- a necessity to avoid violent outbursts.

In the early 1990s, Options started providing services to those with developmental disabilities through the Medicaid Waiver, which permits federal funds to be used for "an array of home and community-based services that an individual needs to avoid institutionalization." Among the requirements for assistance: "The recipient would require institutionalization in the absence of the waiver and/or other home-based services."

Medicaid has five waiver types, which are administered through state governments. In Indiana, the responsibility falls to the Indiana Family & Social Services Administration (FSSA), which distributes the federal funds to agencies like Options to hire professionals like Willman to care for folks like Ron.

The bulk of individuals served by Options falls under the Autism Waiver and the Developmental Disabilities Waiver, which includes conditions like cerebral palsy, Down Syndrome, Angelman Syndrome and others, Willman says. Most of the rest are covered by the Traumatic Brain Injury Waiver.

FSSA says the Autism Waiver helps individuals living with their families or in other community settings to "gain and maintain optimum levels of self determination and community integration."

The Developmental Disabilities Waiver helps individuals stay in their own homes or in community settings and assists those who "transition from state operated facilities or other institutions to community settings."

On Nov. 10, the State announced $34 million in new budget cuts, which includes a 5 percent cut in reimbursements to hospitals serving patients on Medicaid. The Associated Press reported the reductions came "in response to state revenue shortfalls and growth in the state Medicaid rolls."

...

In January, their time alone together, and by extension Ron's hikes, will most likely come to an end.

Like nearly all Options houses, Ron's place houses two roommates and one support provider manning each of three shifts. Each roommate also has one-on-one time with individual providers every day. Ron and John's hikes are part of that routine.

Under the cutbacks, each house will now have three roommates, Willman says. And they are now classified on a scale of 1 through 6, with 1 needing the least support and 6 the most.

"When Ron's funding was reviewed recently, he was determined to be in a Category 3," Willman says, "which is kind of preposterous, given some of the behavioral issues he's had."

After an appeal process, Ron was reclassified to a 5, which Willman says leaves him wondering just what a 6 might be. But the chances that Ron will have any, let alone enough, time for riding in the car and hiking in the woods are slim.

"I can't stress enough what a catastrophe it's going to be for his life," Willman says. "I mean, basically his home will be his prison. He will not have freedom of choice. He will lose the routine."

Ron Habney's is but one story among dozens at Options, Willman notes. And the waiting list for others to even get services through the Medicaid Waiver is roughly seven years.

Autism and Food Stamps

WRTV in Indianapolis reports:

The family of an Indianapolis man with autism is suing the state's social services agency, saying it illegally cuts grocery benefits it pays to developmentally disabled people enrolled in a Medicaid program based on how much they receive in food stamps.

The American Civil Liberties Union of Indiana filed the lawsuit against the Family and Social Services Administration on behalf of 26-year-old Michael Dick last week in Marion County Superior Court, 6News' Derrik Thomas reported.

Dick has been severely autistic since birth, is nonverbal and functions on the level of a 6- or 7-year-old, his family said.He's enrolled in Indiana's Developmental Disabilities Waiver Program and receives food stamps from the federal government.

But his family claims that when the federal program increased its benefits by $1.25 a day in 2009, the state deducted that same amount from his living allowance.

Talk About Curing Autism looks at food stamps from a different angle, calculating how to afford a gluten-free, casein-free diet on a very limited budget.

Generation Gap in Perceptions of Autism

At the Bloomington Alternative, Steven Higgs suggests that there might be a generation gap in perceptions of autism. He writes of Travis Roach, a young man with Asperger's, his mother Lisa, his sister Chelsea, and her friend Megan:

In terms of negative reactions to Travis, Lisa casts the tale in generational terms. "There's a couple adults at McDonalds that's had problems with his talking," she says. But Chelsea and Megan's generation -- both are college seniors -- has grown up with the nationwide epidemics of autism and developmental disabilities, such as attention deficit-hyperactivity disorder and learning disabilities. More than one in four children in the Metropolitan School District of Mount Vernon -- 26.1 percent -- received special education services during the 2008-09 school year, according to Indiana Department of Education data.

"They don't think anything about them," Lisa says. "It's adults who have problems."

And that reminded me of another salient moment I experienced with the father of an elementary-aged boy with Asperger's. Only somewhat tongue-in-cheek, he suggested a day's worth of awareness-raising events where kids with autism mix with the public. His suggested title for the event:

"Get Over It, It's Autism"

Dan Burton Survives His Primary

Dan Burton (R-IN), Capitol Hill's leading advocate of the vaccine theory, narrowly won renomination yesterday. The Indianapolis Star reports:

For the first time since he was elected in 1982, the majority of voters Tuesday did not back U.S. Rep. Dan Burton in the 5th Congressional District's Republican primary.

In fact, 70 percent voted against him. And it didn't matter.

Burton still won, collecting 30 percent of the vote -- enough to edge out six contenders and all but ensure him a 15th term in Congress, representing a district that has never sent a Democrat to Capitol Hill.

In November, Burton will face Democrat Tim Crawford, who defeated Nasser Hanna.

Former state Rep. Luke Messer came the closest yet to knocking off Burton, collecting 28 percent of the vote.

He and the other five challengers who ran against Burton tried to tap into a national mood swing against Washington incumbents and growing concerns about the policies of President Barack Obama, and it almost worked.

Politico earlier reported: "Health and pharmaceutical executives are throwing thousands of dollars to the Republicans challenging Indiana Rep. Dan Burton in next week's House primary, deepening the longtime industry critic's woes as he battles to capture his party's nomination." But a search of FEC records reveals that such contributions accounted for only a small fraction of Messer's total.

Indiana News

An update on the seclusion-and-restraint story:

A Perry Meridian Middle School teacher and classroom aide accused of improperly restraining a special-education student have been charged with two felonies.

Catherine Littleton and instructional aide Jeffery Stokes in February allegedly used belts to strap a seventh-grade student to his chair and bound his hands with masking tape, said Perry Township Superintendent Thomas Little.

According to court documents filed this week in Marion Superior Court, Littleton and Stokes face three charges: criminal confinement, a Class C felony; neglect of a dependent, a Class D felony; and battery, a Class B misdemeanor.

Advocates for people with disabilities said Friday that the charges reflect an increase in reports of abuse of special-education students. Perry Township has dealt with two previous reports, and earlier this week, an Indianapolis woman claimed in a lawsuit that an Indianapolis Public Schools teacher's aide traumatized her developmentally disabled son in January by tying him to a chair with a belt.

6News reports:

Autism is the fastest-growing developmental disability in the nation, and Indiana ranks near the top.

The state is fourth highest for the number of children living with the challenging and confusing disorder, 6News' Stacia Matthews reported.

Across the country, the number of children diagnosed with autism has exploded upward by 600 percent in the last 20 years.

Nationwide, the disorder strikes 1 in 110 kids, while the rate is 1 in 100 in Indiana.

Doctors attribute the higher number to a statewide system of highly trained doctors who can diagnose the disorder early on.