One of our concerns when we first started early intervention (EI) was whether we could get appropriate services for Moe, given the California budget crisis. By law, California must provide appropriate services for all qualified children, but of course "appropriate" and "qualified" are squishy terms. We've been fortunate enough and pushy enough to get the right services for Moe.
At the end of January, I attended a parents' meeting with our ABA provider about budget cuts that are coming their way. I learned a number of interesting things at this meeting.
First, parents are having more and more success with insurance. It is always a fight, and often takes many months of appeals and reviews, but parents have been able to get insurance coverage for autism treatments, including ABA, speech and OT. The providers love when they do get insurance clients; they get better rates, fewer hourly caps, and can provide more services, especially with kids over 3. This is because health care providers are concerned with "quality of life" where school districts (who manage services after age 3) are only responsible for addressing issues that affect educational success. Our provider believes (or maybe hopes) that insurance is the future of autism coverage.
Second, I learned that many more parents than I realized are paying out of pocket for their kids' therapies, either entirely or to supplement what they are getting from the school districts. Many of the parents at the meeting were from an excellent nearby school district (not ours), but one that I'm told doesn't have great special ed services. I've heard good things about our school district, which doesn't contract with the center but provides their own programs. But until we see the specific program that we are offered, it is hard to tell. We're going to start looking at some of the other agencies around just in case.
Third, I learned that the Regional Centers and the School Districts are being much tougher with their definitions of "qualify" and "appropriate." Where 80% of our provider's clients used to be big (25+ hours/week) programs, 80% now get fewer than 10 hours. Their center-based program is filling up since the RCs are more likely to recommend a cheaper center than an intensive home program. This is what happened to us. Fortunately, we got second opinions and very strong hints from the center director that Moe needed more. We pushed to revise our IFSP, and we got more. But not everyone knows enough to push for that.
Of course, providing fewer services during early intervention is only going to cost the state more in the future. Kids who don't get services early on are more likely to need more help later, continued services into high school and adulthood, including job training, self-help skills training, home assistance, etc. With the rates of autism rising, this is a potentially big financial burden building for the state and the nation as a whole. But the state is not run like a business, with a long term fiduciary duty to its stakeholders. The state lives budget year to budget year, and our kids are the ones who are going to suffer. There may be a number of problems with insurance companies covering autism care, but they are savvy businesses, and likely to take a longer term view of the problem.
So far, state budget cuts have only affected my family a little bit. At Moe's latest IFSP, we had to get a denial of coverage letter for speech and OT services before the RC would pay for them. Our ABA provider has had to reorganize to brace for the cuts but our program was only affected a little bit. But as we prepare for our first IEP and transition into the school district in May, I have a feeling we're going to start feeling the crunch a lot more.
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