Skip to comments.Florida must pay for autism therapy for poor kids, judge says
Posted on 03/29/2012 5:16:30 AM PDT by Cincinatus' Wife
...U.S. District Judge Joan Lenard, in an order signed this week, required the state's Medicaid insurance program for needy families to begin paying for a psychological program, called applied behavioral analysis, designed to improve the behavior, language and cognitive development of autistic children. The state already requires commercial carriers to provide the therapy, also called ABA, to Floridians with private insurance meaning children from poor families were being denied services more affluent children could access.
In a blistering order, Lenard called "outrageous" the state Agency for Health Care Administration's position that behavioral therapy is an experimental treatment that is not widely accepted by experts in the field.
....Although the ruling impacts only Florida at the moment, it could have significant implications for other states, many of whom don't provide coverage for the therapy through their insurance for the poor.
....But under the state's Medicaid law, Florida taxpayers will not fund health care that is not "medically necessary." In her ruling, Lenard deemed the state's determination that ABA was not medically necessary "arbitrary, capricious and unreasonable."...
(Excerpt) Read more at tampabay.com ...
... so it is spoken, so it shall be ....
File under "Why health insurance costs so much."
Well, then all wealth must be redistributed so that the STATE can "care" for the masses properly. No need for charity and family.
1. I don’t have a problem with this legislatively, but this is another example of judges legislating from the bench.
2. TRULY autistic kids need the help if they are going to be productive later on in life. I don’t have an issue helping foot the bill for that miniscule population as a safety net (if passed on a legislative level). On the other hand, they now have autistic “spectrum” where they can pretty much label anyone as autistic that displays any signs of social akwardness. Look for the leeches to use this to get free daycare.
However, "The state already requires commercial carriers to provide the therapy, also called ABA, to Floridians with private insurance" if the therapy is questionable in its effectiveness, why are private insurers required to provide it?
Although I agree that the Medicaid program ought to include this treatment, I am troubled that a single judge has the power and authority to order the state to provide it simply because the judge thinks it is necessary when it has been deemed to be experimental apparently by a panel of experts.
The tyranny of the judiciary has run amok.
Full time ABA can cost $100,000 a year. It can be a good choice for some kids. In CA lawyers abound who sponge off the school districts and get them to pay for these treatments. But note that no district or state has that much money and one kid in 88 has autism. If a gourmet restaurant is ordered to keep giving away their steak dinners for free, you do realize the quality of the meat will go down. Right?
I agree and I'm glad you brought up the "Autistic Spectrum" because it has become a catch-all and swelled the numbers of children they've "identified."
A recent study in Canada was done on ADHD:
ADHD diagnosed in December children more often, UBC study finds "December babies are significantly more likely than their classmates to be diagnosed with attention deficit hyperactivity disorder, a new study of nearly a million B.C. children has found.
The results suggest that some children are being put on drugs for ADHD merely because they are not as mature as older children in their class.
Published this week in the Canadian Medical Association Journal, the study found that girls born in December were 70 per cent more likely to have an ADHD diagnosis than girls born in January, while boys born in December were 30 per cent more likely to have a diagnosis of ADHD than boys born in January.
Similarly, girls were 77 per cent more likely and boys were 41 per cent more likely to be given a prescription for a medication to treat ADHD if they were born in December than if were born in January.".......
If the excerpt faithfully represents the facts of the case — that Florida was denying coverage based on the assertion that ABA therapy is experimental — then the case was rightly decided. My wife’s clinical internship in psychology included an autism rotation, and ABA treatments are hardly experimental. The particular form applied to autism, called discrete trial training, is the standard treatment for a variety of vexing disorders including the social skills deficits shown in autism (e.g. not being able to correctly interpret others’ facial expressions) to the inability to swallow found in young children who were on a feeding tube early in life. It is generally quite effective.
ABA is already and has been for years, in use in the state of NY. I work for a non profit agency that serves the developmentally disabled pop. and their behavioral needs are monitored by the applied behavioral analysts. It has long been an inside joke among those who have worked for years in this field, that the behavioral interventions literally do nothing to help the individual. Autism spectrum is one of those diagnoses that is deceptive as there is no medical test for the condition. Recently, however, those with Asperger’s syndrome, once a form of autism, are now deemed not eligible to be classified as autistic and are now in the category of “psychiatrically impaired.” NYS spent so much of the tax payer money on these programs in the past through the Medicaid system that now they have to implement another waiver into the spending bill and change the way the programs are funded. The problem is that even though one would hope that local charitable and familial help would provide adequate services for the kids with true autism, that almost never happens. Therefore, the school district has to step up to the plate and find services. There is just no easy answer.
Your cost estimate is based on having a licensed psychologist or certified behavior analyst provide all the services. One of my wife’s doctoral students showed in her dissertation that discrete trial training for autistic children (the particular form of ABA relevant here), once the regimen is chosen by a relevantly trained professional, can be effectively carried out by school paraprofessional aids. (The paper based on the dissertation is still in preparation for submission to a peer reviewed journal, but . . .)
You nailed it perfectly, wolfman. Truly autistic children face considerable challenges, and I would not be opposed to legislation seeking to aid them or in helping to pay for said service for those who families who *genuinely* could not pay for it themselves.
Like you, however, I’m skeptical of what the practical application of this ruling could mean. We’re seeing the law of unintended consequences in so many things already. And I’m always uncomfortable with judgments from the bench that seem to be driven more by politics than by interpreting the law.
Because the therapists who provide the therapy organized themselves and their patients/customers to lobby the legislature to pass the mandate, while most people simply weren't paying attention. This is why all sorts of treatments with relatively few providers and users are mandated by state governments. Each one doesn't seem like much, but all together, they add up to much higher insurance premiums for everyone.
Ditto to this post!!
As both a mom and grandmother of autistic persons, I agree with both statements. We need to have help for those who cannot afford it, but be CAREFUL when legislating it from the bench. The spectrum can be BROAD and thus abused terribly!
This is the same reasoning that demands tax-funded abortion: rich people can pay for it, so it must be “free” to the poor.
However, it never seems to be applied to school choice!
They don't all turn out to be Temple Grandin. The whole thing has become another RAT union-employment-to-no-end scam. Meanwhile, the school is threatening their GATE program for gifted and talented education.
Fair enough. I live next to one of the high powered attorneys that make school districts quake. He won’t look up from his desk unless high five figures make it there first. But then he gets the taxpayers to pay for it all. The autism programs are probably bloated and costly BECAUSE taxpayers foot the bill.
I’m coming around to the opinion that the entire file of psychology should be forbidden by law. Of all the people I’ve met in my life without doubt psychologists are the most screwed up of the lot.
I get the impression that people study psychology trying to help themselves. People who are reasonably okay become engineers or chemists.