State Officials Deny Cover-Up Claims

by David Gorn


A Kaiser physician and the mother of a child with autism claim state officials knew coverage would change when California moved children from the Healthy Families program into Medi-Cal coverage but wanted to keep the information hidden.

State officials said the assertions are simply not true.

In a January letter to beneficiaries of the Healthy Families program, state officials assured families they would retain "all of the same services" after the switch to Medi-Cal managed care plans.

But not all children in Healthy Families have the same coverage under Medi-Cal. Some children with autism who receive a specific kind of treatment -- applied behavioral analysis known as ABA therapy -- are no longer eligible for it.

Roughly 400 children lost ABA therapy coverage when they left the Healthy Families program. They have been referred to regional centers run by private companies contracting with the state to provide or coordinate services for low-income Californians with developmental disabilities, including autism. The eligibility criteria are different at regional centers, and children's advocacy groups estimate that three-quarters of those receiving ABA therapy under Healthy Families would be ineligible for that therapy at the regional centers.

In the Jan. 1 letter, Department of Health Care Services wrote, in bold-faced type:

"Your child will continue to have all of the same services during this move. ...  Your child's coverage will not be interrupted."

Alice Mayall, a mother from Livermore, said that sentiment was similar to DHCS testimony during legislative hearings to grant approval for the transition to Medi-Cal. She said DHCS officials led parents and legislators to believe all services would continue under the transition, while knowing that ABA therapy services would not continue in the same way.

"I felt it was incredibly dishonest, and it seemed to be a systemwide dishonesty," Mayall said. "There had to be an awareness by DHCS [officials] that there would be no [ABA therapy] services under Medi-Cal."

She contends the information was kept under wraps so state health officials could get legislative approval more easily.

"Everybody [at DHCS] knew it ahead of time," she said. "But there was this attitude that we're not going to talk about it, because it's not going to be pretty."

Not talking about it extended to Kaiser's health plan, according to Sheldon Orloff, a pediatric nephrologist and the regional director for pediatric rehabilitation and subspecialties departments at Kaiser. 

"We have not been allowed by the state to tell … of the impending loss of ABA covered services through Kaiser, despite our desire to do so," Orloff said.

"They told us in no uncertain terms that we couldn't send out notifications to the families on multiple occasions," Orloff said. "And we're still not allowed to send any letters until the transition is over."

Orloff said it makes no sense to inform people about changes after they've already happened, Orloff said. 

"To me, it makes no sense at this point in time," Orloff said. "You might as well be up front about it."

DHCS officials said the assertions are simply not true.

"DHCS did not ask any partners to refrain from speaking about ABA therapy services," said Norman Williams, deputy director of public affairs for DHCS.

Williams said determinations are still being made on how to handle the ABA therapy question.

"DHCS is still assessing the specific availability of ABA services for its Medi-Cal members," Williams said. "We are working to ensure Medi-Cal members continue to have appropriate access to behavioral health services.  We are also collecting information and surveying our health plans regarding behavioral health services to determine the number of Healthy Families … children transitioned to Medi-Cal who currently receive these services." 

Karen Fessel
DHCS has said for months that they are working on this issue to ensure that Medi-Cal members continue to get behavioral services. If that were true, they would not have let families lose the services in the first place!! Mr Williams' statement only affirms the major point being made by Mr Gorn, -- that DHCS is trying to cover up and minimize the reality that children with autism can no longer obtain these services. This is despite the fact that the law governing the transition included explicit statements that no services would be discontinued due to the transition. CMS approved the transition with this explicit understanding. DHCS has not followed the law or their agreement with CMS, which is why they continue to cover up their actions. We expect more from our government. Karen Fessel, Dr PH Autism Health Insurance Project
Kristin Jacobson
The administration had ample notice that its statements to families, advocates, health plans and the legislature about continuing care were incorrect. Advocates have been warning the administration about the impending loss in services to families struggling with autism since June, 2012 when the trailer bill language to eliminate Healthy Families was introduced. Health Plans and Legislators joined in warning DHCS in the fall of 2012 and continued throughout the implementation as hundreds of children lost services, just as was predicted. The Administration acknowledged the likely serious and irrelarapble harm caused by ANY delay or denial of behavioral health treatment to individuals with autism, and yet proceeded to permit the abrupt discontinuation of services and the anticipated, and now actually documented, harm to be inflicted. Now the Administration is erecting and hiding behind false legal claims that the treatment is not offered under Medi-Cal. Their behavior is unconscionable!

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