Autism Families Directed to Regional Centers

by David Gorn

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Department of Health Care Services director Toby Douglas testified yesterday that some Healthy Families participants will probably lose a type of autism service in the transition to Medi-Cal managed care plans.

The service -- applied behavioral analysis -- is still covered by Medi-Cal, Douglas said, but in a different way. Families with an autistic child will need to reapply for the service through the state's regional centers, where eligibility criteria are stiffer. Some children who qualified in Healthy Families may not be eligible under new guidelines, officials said.

Douglas testified yesterday before the Assembly Budget Subcommittee on Health and Human Services. His disclosure rubbed a number of legislators the wrong way.

"I feel a little like a hamster on a wheel," said committee chair Holly Mitchell (D-Los Angeles). "When the budget document was in front of us before, we asked just these questions. If this goes through, what happens? We saw this train coming. For us to go through elimination of the [Healthy Families] department, and now to have story after story from people who aren't getting services…." Mitchell raised her palms up in frustration.

Douglas said he never promised that Healthy Families recipients would keep all of their Healthy Families services.

"We did talk about changes that would occur," Douglas said. "We did not say that nothing in their benefits would change."

Douglas said applied behavioral analysis for autism patients will still be a Medi-Cal benefit, just not a Medi-Cal managed care benefit.

"Yes, things have changed with ABA services, it is no longer a benefit of Medi-Cal managed care, [but] it's a benefit through the regional centers."

According to Kristin Jacobson, co-founder and president of Autism Deserves Equal Coverage, regional centers have much more stringent eligibility qualifications and about 75% of the autism families in Healthy Families don't qualify for ABA at the regional centers.

The state has contracted with 21 private not-for-profit regional centers that will provide or coordinate services for Medicaid beneficiaries with developmental disabilities, including autism.

"It's going to be devastating to families to not have this therapy," Jacobson said. "Regional centers don't cover all kids on the autistic spectrum, so it's not a solution for 75% of the autism population."

"I can't say there aren’t consequences," Douglas said, "since it's a benefit that isn't provided by health plans, and it was provided in Healthy Families."

Douglas was pressed by Assembly member Allan Mansoor (R-Costa Mesa), who had a written statement from DHCS to beneficiaries that said benefits would remain intact.

"Does that statement not apply to ABA services? Is that statement true?" Mansoor asked.

"The statement is true," Douglas said. "What isn't reflected is, it's still a benefit within Medi-Cal, but you may not qualify [for it]."

Rachel Yanez
Are any of the individuals involved and responsible for this transtion plan even reading these posts? If so, why are there no responses? These issues are of utmost importance not just to us working in the healthcare field, but most importantly, to the children being affected by this unorganized, disjointed plan that seems to be falling apart at the seams. We have millions and millions to send to other countries but can't seem to save our own? I'm for helping others, but we MUST take care of our own home first before we can go help others excavate out of their messes.
amour Soto
Very simple: The Healthy Families transition to Medi Cal is one of the most irresponsible incompetent transitions I have ever seen. Gov.Brown and his administration need to seek a solution immediately or suspend the future phase of the Healthy Families transition to prevent any further children from losing services.Parents and advocates were told that this transition would not result in a change of services for our children.
Rachel Yanez
For those working w the Medi-Cal population during transition phase & beyond, it is extremely frustrating to read this. When info was released to CAAs, the message was "Benefits will not change, they will now simply be under Medi-Cal..." We forwarded a message and it has come back to bite us by instigating mistrust from those we are trying to help. As an employee of a primarily Medi-Cal pt base IPA and a CAA who takes pride in completing and doing her job well, this creates and makes for ill will from those who have previously reached out to us. Perhaps the higher ups in Washington & Sacramento should be forced to receive their healthcare via Medi-Cal (with the current guidelines) for a minimum 1-year period; have them experience first hand what it's like. I'm sure the limitations on pt care and low payments imposed on providers would dramatically change!
Alice Mayall
I am a parent of a moderately/severely impaired child with ASD who is not eligible for Regional Center services. My son's medically authorized ABA therapy was revoked because of the transition. Information from DHCS regarding the transition was remarkably misleading. A DHCS letter dated 1/1/13 said, "Your child will continue to have all of the same services during this move. Your child's coverage will not be interrupted." A letter from 3/13 noted, "Children in Medi-Cal will continue to have the medical, dental, health, alcohol and drug treatment, vision, and behavioral health services that they had in Healthy Families." In my son's therapeutic school, the students are encouraged to take responsibility for inappropriate behaviors and statements (including lying), and to work towards resolution with the effected parties. I hope Mr. Douglas will take responsibility for the misinformation his agency disseminated and work towards a true resolution with senators and families

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