Northeast Florida parents of autistic children and their therapists are calling on state health regulators to speed up Medicaid coverage approvals for a specific therapy.
Applied Behavioral Analysis is widely used to help autistic people control harmful behaviors and learn to communicate better.
But advocates said a recent state-contractor switch is making patients miss treatment.
Florida in mid-March terminated the state’s contract with a third-party administrator named Beacon Health Options who was in charge of reviewing applications for Medicaid coverage of autism therapy. The Agency for Health Care Administration said Beacon Health Options had become a rubber stamp on claims and the volume of children receiving ABA services was much higher than expected.
On top of that, the health agency said unqualified providers were bilking taxpayers for unnecessary services. So Medicaid patients are now being asked to reapply for coverage under a new contractor.
Still, at a rally on Thursday, Jacksonville mom Marie Quiñones said legitimate patients are being caught in the crossfire.
“They need to follow a process that is fair and that is due diligent. I don’t think [they’re doing their due diligence] right now. Because if they chose a provider or a third party administrator that has little [or] no experience [with ABA] and they’re now setting themselves up to be able to do this, they need to find, at least temporarily, a plan B,” she said.
Quiñones, the mother of two autistic children, said her children’s therapy has been in limbo. She’s received a conditional approval but not the associated approval numbers she needs to get coverage with her provider. She’s worried their therapist will drop them.
“Regression is one issue. You regressed because if you’re not able to receive the services, behavior starts coming back. It could actually be reinforced worse… because you don’t have the therapist to help you work through them,” she said.
The state said they have no records of patients’ experiencing interruptions in treatment and that claims to the contrary are “untrue and misleading.” In a statement emailed to WJCT News Thursday, the agency said patients who need the services will continue to receive them.
“There is absolutely zero loss of services for children that need BA therapy… To crack down on widespread fraud and abuse and to protect taxpayers, AHCA recently put a moratorium on new providers in Miami-Dade and Broward counties. This does not apply to [Jacksonville],” AHCA spokeswoman Mallory McManus wrote.
McManus added that between “March 26, 2018 (when the reauthorization process began with new contractor eQHealth Solutions) and June 23, 2018, more than 7,500 recipients were authorized to receive services in Florida.”
McManus said she urges parents experiencing difficulty with the process to call AHCA at 1-877-254-1055.