Alright – so, where do I even start with this blog. My head is spinning. If you follow my blog or know me then you understand my love/hate, ok mostly hate with Minnesota health plans. Let’s explain a bit to anyone new to this blog. Over a decade ago, there was a black boy with autism who was denied autism therapy (ABA) by Health Partners. This child had Medicaid via Health Partners. In parallel, the MN state Medicaid agency (aka DHS) was approving autism therapy to mostly non-minority children with autism who had fee for service Medicaid. Long story short, this child’s family hired a local attorney who was also an autism mom. They sued HealthPartners and won.
This was the gift that was going to drive my autism advocacy which we successfully advocated in both Minnesota and at the federal level to cover autism therapy for ALL Medicaid children with autism. All good, right. Not so fast. They always come up with another way to screw with our kids. In theory, health plans are supposed to follow the same rules as DHS when covering autism therapy. At least that is what I and others did back when Gov Dayton was here. We worked with state legislatures, DHS’ asst commissioner Nathan and CMS (this is a long video, I miss IACC but not the 8-hour meetings; the CMS coverage part is about 6:48 time towards the end) to ensure equity and equality. So we thought.
Now access is the law, but the rules are different similar to when black Americans were told you can vote but hold on now, you need to pass a difficult reading test. Low-income children with autism who have a health plan via Medicaid can now access the services but the rules are sooooo harder for providers. This means the provider will simply not take the MCO autistic kid which creates what? that is right more disparity, you know Minnesota’s middle name. I like to call it the land of 10,000 racial disparities.
DHS held what they are calling meet and greet events with health plans. So far two (BCBS & HealthPartners) have presented. What they said is yes we will pay for autism therapy but you will need to follow more difficult rules and processes than DHS. The provider has to get their practitioners enrolled with DHS which is good then get enrolled with the health plan which is also good. Wait for it, here comes the reading test. DHS will retro pay the services provided by the practitioners but the health plan will NOT. In other words, the agency will not be reimbursed for the therapy they have provided to the family. Now, what now? what the heck?
So this means the EIDBI agency will have to eat this cost. Tell me what agency can survive by not getting reimbursed for services they have provided? Why would any agency do this? who suffers? you guessed it – the child and the family.
I am soooooo pissed right now, I don’t even know where to start. I want to retire because I am old, tired, and have been doing this for 15 years. I do not see anyone else who wants to continue this thankless headache.
As I think through this. I really think fighting with crappy DHS or even the health plans is not the answer. We just need to write a law that says the patient has the right to opt-out of the health plan. Rep. Liebling had a bill about it this year, but Sen. Utke was against it, and it did not pass. I think we can revive this if we come at it from the patient and the provider’s perspective.
MCOs are simply not working for the member nor for the provider – period. They have unnecessary and different rules than DHS, are mostly rude, cruel even, and suck. Not a typo.
Here are my previous blogs on Medicaid paying for low-income children with autism. I mean seriously – isn’t Medicaid for the poor?
CMS approves autism coverage for the whole country!
July 8th, 2014 IACC meeting where this awesome news is announced. It is now 2022, and the fact that we are still asking for the same thing is why we have horrible and shameful racial disparities in Minnesota.
The above words do not reflect any candidate, agency, or committee.
Idil – Somali Autism Mom & Advocate