This story was produced as part of the Colorado Capitol News Alliance. It first appeared at cpr.org.
On Tuesday morning, around a hundred people gathered on the west steps of the state Capitol. The mood was serious.
“I'm asking our leaders, all of you, to do what's right and not what's easiest: protect behavioral therapy funding,” Katie Gallardo, a Longmont parent whose son has autism, told the crowd.
Gallardo said a type of therapy known as ABA, Applied Behavior Analysis, has helped her son communicate, learn and build skills. But the state, in order to balance a struggling budget, is reducing funding for providers who offer this and other forms of pediatric behavioral therapy.
Will Martin, a provider with Soar Autism Center, said the cuts have been relatively deeper in that area than others.
“We're asking the administration to find another solution that doesn't balance the budget on the backs of kids with autism,” he said.
Behavioral therapy funding is administered by the state's Medicaid program, which has seen skyrocketing costs; state analysts predict the growth in Medicaid spending is the main driver in billion-dollar shortfalls predicted for next year’s budget, and the year after it.
Governor Jared Polis, a Democrat, has said that's unsustainable.
“Governor Polis submitted a responsible, balanced budget proposal that fully funds schools, funds public safety improvement, and increases funding for Medicaid by a record amount to ensure our most vulnerable Coloradans continue to have access to the care they need and deserve, now and in the future,” spokesperson Shelby Wieman said in an emailed statement responding to Tuesday’s rally.
Within Medicaid, the second largest spending category is long-term care for people with disabilities. But the governor’s proposed reimbursement rate for providers could jeopardize children’s ability to access treatment, advocates said.
“If this continues, many clinics like mine, clinics families rely on, will cease to exist in Colorado,” said Rebecca Urbano Powell, who runs a program called Seven Dimensions.
Parents at the rally said early, high-quality behavioral therapy is life-changing for their children, and potentially a long-term cost-saver for the state, with the potential to dramatically reduce the need for lifelong support.
“There's a return on this investment with children,” said Valerie Dillon, of Golden, mom of a five-year-old with autism. “My child, in assisting her, in helping her to be a productive member of society, she might not have that opportunity without this therapy.”
Sabrina Ortengren, from Conifer, said her son Ethan has profound level three autism, the most severe type. He's 6’5” and 400 pounds and can be aggressive. But she said therapy has helped.
“It's amazing. They've taught us how to work with him, things to say with him, how to intervene to keep him safe, keep us safe,” she said.
Ortengren called the therapy a blessing and urged leaders to find another way to balance the state's budget.
During an August Stakeholder Webinar, the state’s Medicaid Director gave a brief explanation of the increasing costs it was seeing in the program, and laid much of the blame on an increasingly profit-driven business model among providers.
“The drivers of these increases we're really looking at are the infusion of private equity into the BA (Behavioral Analysis) space, by purchasing up centers and other practices,” said Adela Flores-Brennan.
She described “inappropriate behavior” that seemed to be fueling this trend. That includes things like requiring families to commit to a minimum number of hours of therapy in order to enroll with a particular clinic, billing for services rendered by non-credentialed technicians, and billing for non-therapeutic services like naps. Flores-Brennan also noted an audit spotlighted concerns about “the type of documentation that is being kept at the practice level.”
Providers don’t see it that way, calling the state’s focus on clinic ownership a distraction.
The state’s Department of Health Care Policy and Financing (HCPF), which oversees Medicaid “created a problem that they are now using to justify the solution that they wanted, which is cutting services for therapies for children with autism and other disabilities,” said Martin, in an emailed statement late Tuesday.
Martin noted that the state only covered autism care for a very limited number of children under Medicaid until the federal government made it a mandate.
The recent growth in Medicaid spending and utilization in Colorado, he said, is a direct result of the state “correcting this historic wrong and children finally receiving the diagnosis and access to care they need and are entitled to.”
