The State of Autism Services in Texas

Objectives Discuss different types of services and ways families can access them. Identify barriers that exist in Texas that prevent some families from accessing services. Identify ways families can advocate for policies to improve access to quality services.

Types of Services Speech therapy, occupational therapy, physical therapy Applied Behavior Analysis (ABA) Counseling Social skills training Equine therapy Music therapy And more...

How Can Families Access Services? Insurance Medicaid State Autism Program Early Childhood Intervention (ECI)

Background: Insurance through employer Over half employer plans are “self-funded” Self-funded plans are provided by large employers who choose to pay claims from their own money rather than purchase a typical insurance policy for their employees. Self-funded plans are governed by ERISA- Employee Retirement Income Security Act of 1974 (federal law) and are not subject to state insurance mandates.

What does this mean? In Texas, the following are required to be covered by state law: Evaluation and assessment services Applied behavior analysis (ABA) Behavior training and behavior management Speech therapy, occupational therapy and physical therapy Medications or nutritional supplements

Because certain behavioral services like ABA are more expensive, employers who offer self-funded plans can choose not to cover this.

Medicaid- ABA In July 2014, The Centers for Medicare & Medicaid Services (CMS) issued guidance to states titled “Clarification of Medicaid Coverage of Services to Children with Autism” in response to increased interest/questions about what Medicaid should cover (ex: ABA). Many states subsequently began to cover ABA services; other states were sued to force compliance

Texas was not among the states to start covering ABA Texas was not among the states to start covering ABA. In fact, a lawsuit was filed by families in Bexar county in 2016 against HHSC for not covering ABA. The state settled the lawsuit, allowing it to avoid providing universal Medicaid coverage for the therapy.

What now?

Medicaid- ST, OT, PT In 2015, the Texas Legislature slashed $350 million in Medicaid reimbursement rates to pediatric therapists. Outcome: Many therapy providers closed down, stopped taking Medicaid clients, or ended up with extensive waitlists. The result was an access to care problem across the state. In 2017, the Texas Legislature restored 25% of the cuts.

Advocates continue to push legislators to fully restore the cuts.

State Autism Program (HHSC) Provides Focused ABA to children with Autism through age 16. In 2015, the legislature eliminated Comprehensive ABA from the program, and limited Focused ABA to 30 hrs/month for 6 months per year. Served fewer than 700 children last fiscal year; 61,910 hours

Advocates have expressed concern about: Clients in Focused ABA regressing due to the 6 month rule (6 mos on, 6 mos off). The Program does not offer enough hours to serve kids with more significant needs.

Update: Draft rules for the Children’s Autism Program were posted for public comment period February 2- 16 Some of the changes included: Requirements about documentation of services provided, including parent training; would collect data on goals and progress Removal of 6 month rule Caps services at 180 hrs/year; 720 hours total Clarifies service limits- 180 hrs/yr, 720 hrs total, until 16th birthday

Early Childhood Intervention (ECI) Program for children 0-3 with developmental delays, disabilities, or medical diagnoses. All eligible children must be served (IDEA Part C) Can provide ST,OT, PT and ABA therapy, case management, skills training, and other services Services are provided in the home and in the community

Approximately 70-75% of clients in ECI are covered by Medicaid. ECI Programs were hit hard by the 2015 Medicaid rate cuts (ST,OT,PT) In 2010 the state was contracted with 58 providers. We are now down to 42.

Advocates recommend Increasing the per child allotment Funding for anticipated caseload growth Restoring rate cuts Improving coverage through private insurance

Review of Barriers to Services: Self-funded employer plans do not have to cover certain services Medicaid in Texas currently denies ABA Medicaid rate cuts created access to care problem State Autism Program has service limitations. ECI providers shrinking across state

What Can We Do? Contact legislators Submit comments to state agencies Provide testimony to a committee Connect with advocacy groups

Contacting Legislators: Email Phone Letter/postcard Office visit Social media!

Public Comment Testify at committee hearings to share your story/concerns with legislators. (Texas Legislature Online) http://www.capitol.state.tx.us/ Testify at an advisory committee meeting. (HHSC) https://hhs.texas.gov/about-hhs/leadership/advisory-committees Provide public comment on proposed rule changes within an agency.

Get Connected! Listservs Newsletters Conference calls Regular public meetings/roundtables Coalition meetings Workshops Conferences

Jolene Sanders, Advocacy Manager jsanders@eastersealstx.org (512) 615-6872 Like us on Facebook: https://www.facebook.com/EasterSealsTXAdvocates/ Follow us on Twitter: @ESTXAdvocates