Autism

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Video: Why the New Autism Benefit Is So Important to Medi-Cal Families

Effective this week, Medi-Cal now covers a key autism therapy, and some 12,000 kids stand to benefit statewide. One of the children who will benefit is Timothy Wilson, a bubbly 6-year-old who will now be able to get Applied Behavior Analysis (ABA) through Medi-Cal, the state’s insurance program for people who are low income. ABA is the clinical standard of care for autism.

Timothy was 2 when he was diagnosed with autism spectrum disorder. “He didn’t say mama, didn’t say dada,” says his mother, Jazzmon Wilson. He threw tantrums and hardly made eye contact. “You just see all your dreams go by the wayside.”

The Wilsons enrolled him in the Regional Center of the East Bay, where children under 3 receive state-funded services. He began ABA therapy, which breaks down everyday skills into bite-sized, learnable portions, then uses repetition, memorization and rewards to reinforce or discourage behaviors. Parents learn to lead their child in the therapy as well. In the video, Jazzmon works with Timothy — or Bubba as she calls him. Seeing him now, it’s hard to believe how affected he was at a younger age. Continue reading

Autism Benefit Finally a Reality for Children on Medi-Cal

Jazzmon Wilson with her son Timothy, 6, who has autism. (Jeremy Raff/KQED)

Jazzmon Wilson with her son Timothy, 6, who has autism and has benefited greatly, Wilson says, from Applied Behavior Analysis therapy, now covered by Medi-Cal. (Jeremy Raff/KQED)

By David Gorn

California health officials Monday are launching a new benefit for thousands of children with autism who are covered by Medi-Cal, California’s low-income health program.

“He’s doing things other kids can do. And it’s those little moments, it makes you just so grateful.”

That makes California the first state in the nation to implement new federal standards on autism care.

The new benefit includes coverage of the clinical standard of care for autism treatment — Applied Behavior Analysis, also known as ABA therapy. That treatment has shown significant results for a cross-section of children with autism.

Of the 5 million children on Medi-Cal in California — that’s roughly half the state’s total children — there are an estimated 75,000  who likely have autism spectrum disorder. Of those children, experts expect about 12,000 children to access the new benefit, based on utilization figures from programs in other states. Continue reading

Details of Autism Benefits — Like Provider Rates — Coming After Rollout

(Getty Images)

(Getty Images)

By David Gorn, CaliforniaHealthline

At the first stakeholder meeting last week to review California’s new autism Medi-Cal coverage, state health officials said many details have yet to be worked out. Medi-Cal is California’s Medicaid program.

New benefits, which include coverage of applied behavior analysis — also known as ABA therapy — begin next week.

Department of Health Care Services officials said many details — including the crucial figure of what the reimbursement rates will be — still need to be worked out. Rates will be discussed at the next stakeholder meeting Oct. 16, officials said. Continue reading

Using Disney Movies to Reach A Son with Autism

The family first used a scene from the movie "Aladdin" to connect to their son. (JD Hancock/Flickr)

The family first used a scene from the movie “Aladdin” to connect to their son. (JD Hancock/Flickr)

By Kathy Shield

Owen Suskind was a normal toddler, learning to speak in full sentences and happily playing in the backyard with his older brother, Walt.

Owen wasn’t merely watching these movies, he was hearing them and learning through the characters.

That all changed at age 3, when Owen stopped speaking, and in the space of a single month, his entire vocabulary was reduced to one word: juice. Owen was diagnosed with late-onset regressive autism. Though his developmental trajectory was typical for children with this form of autism, this fact offered no comfort to his parents.

Today, Owen has grown into a relatively self-sufficient young man. He graduated from a college-like program for young adults on the autism spectrum and is now living semi-independently in an apartment. Continue reading

Long-Sought Autism Therapy A Medi-Cal Benefit, State Says

(Getty Images)

(Getty Images)

By David Gorn, California Healthline

State officials Tuesday said autism therapy clearly is a covered Medicaid benefit, and they hope to submit a state plan amendment by Sept. 30 to start the process to make it a benefit for those under age 21, enrolled in the state’s Medi-Cal program. Medi-Cal is California’s version of Medicaid.

According to René Mollow, deputy director of benefits and eligibility at the Department of Health Care Services, Medi-Cal children are entitled to applied behavior analysis — known as ABA therapy.

“Right now we’re working on the development of a state plan amendment. We want to engage the stakeholders in developing that,” Mollow said. “We’re looking to have it submitted at the end of September, and having it retroactive to July 1.” Continue reading

Long Way to Go Before State May Authorize Autism Therapy as Benefit

(Getty Images)

(Getty Images)

By David Gorn, California Healthline

State officials on Friday said they have not determined whether or not to offer applied behavior analysis (ABA therapy) as a Medi-Cal benefit to children with autism.

Federal officials earlier this month issued guidance on the subject, saying it is covered for Medicaid beneficiaries under age 21 as part of the Early and Periodic Screening, Diagnosis and Treatment program.

“Under the Medicaid state plan, services to address [autism spectrum disorder] may be covered under several different … benefit categories,” the CMS guidance said. For children, it said, “states must cover services that could otherwise be covered at state option under these categories consistent with the provisions … for Early and Periodic Screening, Diagnostic and Treatment services (EPSDT). Continue reading

Feds Say Autism Therapy Now Covered As Children’s Medicaid Benefit

(Getty Images)

(Getty Images)

By David Gorn, California Healthline

CMS officials released federal guidance for states on Medicaid coverage of autism therapy on Monday, and that guidance indicates it is covered for beneficiaries under age 21.

“ABA therapy must be covered (by Medi-Cal). It’s very, very clear.”

“It’s a good day. It’s such a good day,” said Julie Kornack, senior public policy analyst at the Center for Autism and Related Disorders, an advocacy group based in Tarzana. “Whenever you get a decision that we’ve been seeking for years, that is a good day.”

Applied behavior analysis treatment, known as ABA therapy, now is a benefit for those under age 21 under the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) provision of Medicaid — and therefore it also must be covered under Medi-Cal, California’s version of Medicaid, according to Kristin Jacobson, president of Autism Deserves Equal Coverage, an advocacy group based in Burlingame. Continue reading

Another Step Closer to Autism Therapy as Medi-Cal Benefit?

(Getty Images)

(Getty Images)

By David Gorn, California Healthline

CMS officials last week approved a state plan amendment for the state of Washington that includes autism therapy as a Medicaid benefit.

It’s the second state in a month to receive that go-ahead from the federal government, and it means autism coverage should be a Medi-Cal benefit in California, as well, according to Kristin Jacobson, president of Autism Deserves Equal Coverage, a not-for-profit autism advocacy group.

The budget passed this week by the California Legislature omitted autism therapy as a Medi-Cal benefit.

Autism advocates hope one day soon CMS will make it clear that applied behavior analysis treatment — known as ABA therapy — should be a required benefit for all states receiving Medicaid, including California. Continue reading

Higher Autism Numbers Announced as Feds Introduce Early Screening Program

(Getty Images)

(Getty Images)

Every two years, the federal government announces the rate of autism. This is what NPR’s shots blog had to say about today’s numbers, which show 1 in 68 children in the U.S. have an autism spectrum disorder.

That’s a remarkable jump from just two years ago, when the figure was 1 in 88 and an even bigger jump from 2007, when it was just 1 in 150.

But officials at the Centers for Disease Control and Prevention officials say the agency’s skyrocketing estimates don’t necessarily mean that kids are more likely to have autism now than they were 10 years ago.

“It may be that we’re getting better at identifying autism,” says Coleen Boyle, director of the CDC’s National Center on Birth Defects and Developmental disabilities.

For one thing, the prevalence seems to vary in different communities and among children of different races. The CDC found white children are far more likely to be identified with autism, even though scientists don’t believe the rates are truly different between whites, Hispanics or blacks.

“What we need to focus on is getting more people identified so they can get the supports they need,” Shannon Rosa, Bay Area parent advocate.

That means that the discrepancy lies in the diagnosis and services available in different communities. The shots blog points out the work of George Washington University anthropologist Roy Richard Grinker.

Along with other researchers, he studied autism prevalence in South Korea. They found that 1 in 38 children there met the criteria for autism spectrum disorder. Grinker thinks that the US number is likely closer to the one they saw in South Korea. Which means that in two years the CDC estimate will likely tick higher still.

Continue reading

New Autism Designation Likely a Central Topic at Statewide Conference

(Getty Images)

(Getty Images)

By David Gorn, California Healthline

A recurring theme at the annual California Association for Behavior Analysis conference starting today in Burlingame likely will be the new definition of autism in the medical community.

Does the new designation make it harder to get a key treatment covered? 
The national guidelines for doctors and other clinicians was updated last year. DSM-5 is the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, put out by the American Psychiatric Association.

In DSM-5, there is a new category in the autism spectrum — social communication disorder, or SCD. Since there are no clinical guidelines for treating SCD, autism advocates worry the new designation could be used by insurance companies to stop covering applied behavior analysis (ABA therapy) in treating autism disorder.

“It’s likely a small percentage [of SCD children among those with autism spectrum disorder], but it definitely will affect some people,” said Karen Fessel, director of the Autism Health Insurance Project. “There are no guidelines put out by insurance companies yet, so likely there will be no adjustments till October this year.” Continue reading