More Info on Medi-Cal for Kids with Autism: MEDI-CAL TO NOW PAY FOR BEHAVIORAL HEALTH TREATMENT FOR AUTISM

Rec'd by email from Judy Mark, Chair of the Government Relations Committee for Autism Society Los Angeles.  Ok to share.

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Date: September 12, 2014 1:41:52 PM PDT
Subject: Medi-Cal to Now Pay for Behavioral Health Treatment for Autism

Hi everyone,

Starting Monday, September 15, Medi-Cal will be required to pay for behavioral therapy for individuals aged 0-21.  Please share the attached information provided by Autism Deserves Equal Coverage with your networks to ensure that families understand their rights under this new opportunity. 

This a new excellent opportunity for many children but it also has some potential significant problems.  I'll give you the good news and potential problems for each type of child:

1. Children who have a diagnosis on the autism spectrum but who are not eligible for regional center services: Good news - If the child is on Medi-Cal, they can call their Managed Care Plan starting on Monday and ask for a list of providers.  Potential Problems - It's going to take a while for the Managed Care Plans to get this up and running and there might be a small amount of provider options.  We are hoping this is not the case.
2. Children who are clients of a regional center BUT the regional centers don't give them needed behavior therapy (and don't get me started on that): Good news: If the child is on Medi-Cal, call your plan.   (If your child isn't on Medi-Cal, you should apply!  Children with autism are eligible for Medi-Cal based on their disability, not on their parents' income. Getting your child on Medi-Cal will not only will help your family but it will bring needed dollars into our state from the federal government.  Talk to your regional center and they will help you apply.) Potential problems - See #1
3. Children who are clients of a regional center and are lucky enough to live in an area with a good regional center that actually provides them necessary behavioral therapy and who is on Medi-Cal (OK, I started):  Good news - You are entitled to stay with your provider and with regional center providing the funding for at least the short term.  Potential problems - At this point, there is only a guarantee of "continuity of care for up to 12 months."  We are pushing for much longer, but we don't know yet.  This means that if your provider does not agree to accept Medi-Cal, you may be required to change behavioral agencies at some.  We are advocating strongly against this but we don't know what will happen.
4. Children who receive behavioral therapy paid for by their private insurance AND the child is also on Medi-Cal: Good news: Medi-Cal will pay for the co-pays.  Potential problems - You need to call the Managed Care Plan to take care of this and they may not be ready yet.
5. Children who have self-funded insurance that doesn't cover behavioral health treatments and currently receive behavior funding from their regional centers: Good news - You will be able to stay with regional center funding for the time being.  Potential problems - If your child also has Medi-Cal, your regional center will require you to shift funding to them if your child is eligible based on their disability.  If you don't have Medi-Cal, your regional center may also insist that you apply for Medi-Cal.
6. Children who are undocumented and are, therefore, not eligible for Medi-Cal: Good news: Regional centers will continue funding your behavior therapy.  Potential problems - You don't have health insurance (sorry, that is another advocacy effort).

Kristin Jacobson, a great advocate from Autism Deserves Equal Coverage in Northern California, is available as a resource if you have questions.  Her information is in the attached Q&A.  If you have any questions or problems, please feel free to contact Kristin who is collecting examples to use in her advocacy.

I know this is complicated but it will affect thousands of children with autism in California.

Take care,

Judy