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Autism - Support Across the Spectrum Autism - Support Across the Spectrum

Is Obamacare What the Doctor Ordered for Kids with Autism?

Posted by on Oct. 9, 2013 at 8:10 AM
  • 51 Replies


s Obamacare What the Doctor Ordered for Kids with Autism?

Posted: 10/01/2013 5:38 pm


On Oct. 1, our nation's health care system will experience significant changes -- changes that many are still debating and questioning. While Sen. Ted Cruz, R-Texas, wasted his constituents' time grandstanding in hopes of thwarting implementation of the Affordable Care Act (ACA), millions of deserving Americans are preparing to have greater access to affordable health care -- access they never had before.

Despite the political wrangling over the ACA, commonly referred to as Obamacare, undeniably it is a game changer. An estimated 14 million people will access health care through a system of exchanges run by states and the federal government. Most people signing up for health care will get subsidies based on income and family size.

This means low-income families, including those with disabilities and special needs, will have more health care insurance and program options. Rather than traditionally depending on emergency rooms as primary care providers and straining over-burdened health care centers around the country, these families will be able to purchase low-cost health care coverage and access much needed wellness and rehabilitative programs thereby alleviating excessive hospital visits. Through several states' exchanges, premiums will cost as low as $100.

As an advocate for special needs children, I'm particularly impressed with the aspects of Obamacare that benefit special needs children. Under the new law, children are allowed to remain on their parents' health insurance plan until age 26, closing an antiquated coverage gap that has plagued families for decades.

Also, children with pre-existing conditions will not be turned away, and for the first time for many families, wellness checks will be a covered cost. This will allow providers the opportunity to better manage the overall health of families, and with children in particular, this can alleviate common childhood illnesses that cause a disruption in school attendance and lead to long-term conditions such as diabetes and hypertension.

With an emphasis on accessing health care through community clinics, Obamacare eliminates transportation barriers that have traditionally made it difficult for low-income families and those with chronically ill or disabled children from accessing health care. In communities like South Los Angeles that has 43 percent fewer health care resources than its more affluent neighbors in West Los Angeles, the community clinic component of the new health care law should inspire the kind of investment in health care centers that the community has desperately needed.

But with all of Obamacare's positives, families of autistic children who rely on Medicaid still have hurdles to overcome. In the last two decades, there has been a dramatic increase in the number of individuals diagnosed with Autism Spectrum Disorders (ASD) across the country. Now one in 50 school-aged children are impacted. According to the American Academy of Pediatrics, ASDs are lifelong neurological developmental disabilities that profoundly affect the way a person comprehends, communicates and relates to others. It is well established that early intervention services for young children with ASD significantly improve children's prognosis and should begin as early as 18 months of age. Further, research indicates that one-third of children receiving early intervention services improved so much that their need for ongoing support was dramatically reduced.

Along with the benefits to the children, early intervention saves states millions of dollars as reports show that many individuals with ASD require lifelong supports at a cost estimated at $3.2 million per person. Early intervention can reduce those costs by more than half over an individual's life span. Yet only nine states will extend Medicaid to include autism therapies.

Given the research and recommendations by the nation's leading pediatricians, the majority of states are not following the doctors' orders. Children with autism need more, deserve more and are counting on all of us to ensure they get more. It's unthinkable that kids whose families are at the lowest end of the socio-economic ladder and who suffer from a lifelong disorder for which there is no known cure or cause have to forego the only medical treatment proven to improve their condition. Could you imagine a law that made chemotherapy unavailable to kids on Medicaid who have leukemia or insulin to those with diabetes? Of course not.

Likewise, kids with autism who receive Medicaid should not be denied access to autism therapies. If health care is truly a right and not a privilege, it cannot be confined to the few, but rather must be made widely available to all families. Making this happen will require more than grandstanding by senators on the floor of the U.S. Senate. It requires progressive legislators who will stand up in state houses around this nation and fight for comprehensive care for kids with autism not only because it will save states millions of dollars, but because it's what the doctor ordered.

by on Oct. 9, 2013 at 8:10 AM
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Replies (1-10):
LicParaMommy
by Member on Oct. 9, 2013 at 9:01 AM
12 moms liked this

I see children with Medicaid getting therapy way before my child does.  My husband and I work our butts off to provide what we have to all of our children.  However, because we have insurance, that does not cover therapy, we have to work extra to pay cash for his therapy.  Should we just quit working and rely on a government hand out?  NO, we are well educated prideful people.  I can't stand articles like this; stating that they aren't getting enough.  What about the families that are stuck in the middle?  The ones who make way too much money a year to qualify for any assistance, but have to work extra to pay for what they can.  It sickens me to death just thinking about it!

Bobcatridge
by Carol on Oct. 9, 2013 at 11:11 AM
5 moms liked this

Since Obamacare was passed, the deductible on our insurance has increased.  Our deductible is $3000 for our anthem blue cross insurance (through my husband's employer).  It used to be the $3000 deductible was for in and out of network providers combined.  Now it is a $3000 for in network providers and $6000 for out of network providers.  That makes for $9000 in deductibles!  Autism treatment is supposedly covered but we live rurally and there are no in network therapists.  I went through all kinds of hoops to get the cognitive behavior therapist and the social skills therapist certified to be treated as in network because there are no in network therapist in a 50 mile radius.  This works good for the cognitive behavior therapist but not so well for the social skills group.  So the insurance only allows a certain amount for each type of therapist. For the cognitive behavior therapist it allows $100 per session even though the session costs $150 per session and for the social skills group it allows $20 per session when the session actually costs $85 per session.  Then it pays 85% of the allowed charge.  We are going broke with the therapy costs.  My daughter goes to a small private school so there is no therapy through the school.  We make too much money to be helped by Obamacare and the only thing I see for us is escalating medical costs because of it. In addition, our general practician and our pediatrition have both retired because they don't want to mess with Obamacare.  For us there is nothing good about Obamacare.

jillymacking
by on Oct. 9, 2013 at 12:09 PM
3 moms liked this

We have the same issue.  We have private insurance as we both work, and we can't get any therapy covered, yet families with state insurance receive those full benefits.

LicParaMommy
by Member on Oct. 9, 2013 at 12:35 PM


Thank you very much.  You feel my pain.

Quoting jillymacking:

We have the same issue.  We have private insurance as we both work, and we can't get any therapy covered, yet families with state insurance receive those full benefits.



lady-J-Rock
by Bronze Member on Oct. 9, 2013 at 1:01 PM
We have insurance through my husband's work and under the Medicaid expansion we were able to get Xavier Medicaid as a secondary insurance. I was honestly shocked at the income guidelines. You can make 25 an hour and still qualify for Medicaid.


Quoting jillymacking:

We have the same issue.  We have private insurance as we both work, and we can't get any therapy covered, yet families with state insurance receive those full benefits.


rthatcher1125
by on Oct. 9, 2013 at 1:42 PM
3 moms liked this
My son gets medicaid...and those special therapies you talk of are not covered where i live...so....we pay out of pocket too...its not just "middle class" at least where i live anyways...
Jenn8604
by Jennifer on Oct. 9, 2013 at 2:02 PM
Yeah when I was talking about it w my friend he was saying the exact same thing. deductibles are going sky high and they also don't mention the outrageous copay at time of service with MOST insurance companies.
Most people are in the same boat as you.
It didn't help.


Quoting Bobcatridge:

Since Obamacare was passed, the deductible on our insurance has increased.  Our deductible is $3000 for our anthem blue cross insurance (through my husband's employer).  It used to be the $3000 deductible was for in and out of network providers combined.  Now it is a $3000 for in network providers and $6000 for out of network providers.  That makes for $9000 in deductibles!  Autism treatment is supposedly covered but we live rurally and there are no in network therapists.  I went through all kinds of hoops to get the cognitive behavior therapist and the social skills therapist certified to be treated as in network because there are no in network therapist in a 50 mile radius.  This works good for the cognitive behavior therapist but not so well for the social skills group.  So the insurance only allows a certain amount for each type of therapist. For the cognitive behavior therapist it allows $100 per session even though the session costs $150 per session and for the social skills group it allows $20 per session when the session actually costs $85 per session.  Then it pays 85% of the allowed charge.  We are going broke with the therapy costs.  My daughter goes to a small private school so there is no therapy through the school.  We make too much money to be helped by Obamacare and the only thing I see for us is escalating medical costs because of it. In addition, our general practician and our pediatrition have both retired because they don't want to mess with Obamacare.  For us there is nothing good about Obamacare.

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darbyakeep45
by Darby on Oct. 9, 2013 at 2:09 PM

I'm not going to say much about this:)  I agree with most of the comments though.

MomOfOneCoolKid
by Gold Member on Oct. 9, 2013 at 2:17 PM
2 moms liked this

There's a lot of good stuff, but the one thing that I needed and desperately wanted -- ABA to be mandatorily covered -- wasn't in there.

The big insurance companies won on that one.

bigmama423
by on Oct. 9, 2013 at 2:23 PM

All I know is, my kids have medicaid, and it rarely covers anything, including therapy and meds.

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