Today the state will begin a transition in the health coverage of 9,000 children who are treated for autism under Medi-Cal, the government program for people with low incomes.
Until now, the children and their families have been cared for at 21 regional centers across California. The centers are nonprofit private corporations that contract with the state to provide developmental disability services.
Starting today, the children will be moved into Medi-Cal managed care plans, which are paid fixed rates to cover treatment.
That kind of change can sometimes force patients to change providers or limit the types of services available to them. And people in the autism community were worried about that.
But state health officials recently clarified that the 9,000 children would continue to get the same care and be able to retain the same providers they’ve been seeing.
On Friday, state officials held a conference call with autism providers and advocates to clear up ambiguity over state rules governing the switch to managed care, which has been in the works for more than a year.
The planned transition had provoked concern among treatment providers, according to Andrew Patterson, president of the Autism Business Association, a collection of 30 groups across the state that provide autism care.
It looked as if one of the state’s new requirements meant autism therapy could no longer be conducted in the same way, he said. But after Friday’s clarification from the state, providers said they were confident that those children will still be able to get the same care with the same providers.
The rule in question would be esoteric to most people, Patterson said. It seemed to prohibit mid-level providers of autism therapy, such as associate behavior analysts and behavior management assistants, from practicing in the same way they have been.
That may seem minor, but it would have caused children to lose their therapists and created huge gaps in care for many of them, Patterson said.
However, the “Department of Health Care Services [officials] said they didn’t intend to say that. They never meant for those mid-levels to be left out,” Patterson said.
The official word came in an email from Anthony Cava, information officer at the department: “The legal requirements are the same for mid-levels providing services in the regional centers as they are for mid-levels providing services in Medi-Cal managed care health plans,” Cava said.
And, he added, if any child has difficulty retaining a provider, the state will step in immediately to make sure there is no gap in care.
Abbi Coursolle, staff attorney in the Los Angeles office of the National Health Law Program, a Washington, D.C.-based health rights advocacy group, said she had heard from a number of families worried about losing services or access to a longtime provider.
“The take-home message is that the state has promised continuity of care, and we will work with everyone to make sure they make good on that promise,” Coursolle said.
Coursolle added that California has been a leader in providing autism services as a Medi-Cal benefit, and that state officials have worked hard to make sure people in need availed themselves of it.
Autism services are different than other therapies, Coursolle said, because disruptions in care have a bigger impact.
“We know that for these kids, small gaps in services can be a big problem and really impact their lives,” she said, “and we’re going to be watching carefully to make sure that doesn’t happen.”
Source: California Healthline