Autism Advocates Disagree With Rosy Assessment of Healthy Families Transition

by David Gorn

TOPIC ALERT:

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.

"On the Healthy Families transition, I would say overall, we feel very good about the Healthy Families transition, that it's gone more smoothly than we even expected," Douglas said at the Oct. 23 hearing.

He said 80% of the Healthy Families children in the transition have been able to stay with the same primary care physician, which is a strong mark of success.

"There have some bumps, especially related to autism and ABA services," Douglas said. "Other than that, on the medical side, on the dental utilization, we've actually been able to institute some new practices on the dental side, given the transition."

Autumn Ogden, policy coordinator for California Coverage and Health Initiatives, a not-for-profit children's advocacy group disagreed.

"Continuity of care means people should continue to receive that same level of care," she said. "That hasn't happened."

Ogden quoted notices that were sent to families before the transition, which assured parents that services would be continued: "While DHCS notified families that 'Your children will continue to have all of the same services during this move,' and 'Your child's coverage will not be interrupted,' they did not elaborate on how to access that."

Alice Mayall, one of those parents who received those notices testified at last week's hearing.

"The notices were very reassuring. But the transition did not work out so well for us, as the notices had led us to believe," Mayall said. Her child, who received ABA therapy under Healthy Families, was one of hundreds of children who were denied that service under Medi-Cal, and sent to a regional center to try to get care.

"It was clear in the fall of 2012 that DHCS was aware that ABA services would be lost as a result of the transition, and did nothing to inform us," Mayall said. "In fact, providers have reported that DHCS told them not to inform parents about the impending loss of services. The lack of information set the scene for patient abandonment."

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."

"It's clear that the department's been responding," said Assembly member Richard Pan (D-Sacramento), chair of the Assembly health committee, which held last week's oversight hearing. "I do think some of this could've been anticipated better. And generally it wasn't clear how people could report issues that came up."

The final phase of the Healthy Families transition begins Nov. 1.


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