Click here to help Autistic Children in Colorado Keep Life-Changing Services

Monday, November 11, 2013

Help Stop Autistic Children From Losing Services

Craig has a book titled, "The Whatif Monster."  The story closely follows a child who's anxiety causes him to reconsider engaging in activities as he worries, "What If?"  In my life, I'm constantly asking myself, "What if?"  When I was pregnant I asked, "What if something goes wrong?"  When Craig's development stopped, I asked, "What if he's autistic?"  When he was diagnosed, I asked myself, "What if we can't get treatment?"  When we moved to Colorado, I asked myself, "What if HIMAT changes?"
Last week, I was devastated to learn that HIMAT will be turned on its head.  The Affordable Care Act no longer allows dollar caps on treatment; this means that Colorado can no longer say, "Insurance companies must pay a minimum of $34,000 per year for the treatment of autism."  Instead, the limit will be changed to the number of visits allowed per year.  The autism community knew this would be happening for a while, but we didn't know what the Colorado Division of Insurance would do about it.  It was left up to this division to determine exactly how much therapy $34,000 per year is worth.

With Craig's therapy clinic, $34,000 buys 8 hours of therapy per week.  In Utah (where apparently therapy is cheaper), it would buy anywhere from 15-24 hours of therapy per week.  Last week, as reported by KOAA, I learned that the Colorado Division of Insurance has determined that $34,000 is worth 4.4 hours per week.  Needless to say, we are distraught.  We moved here from Utah to secure long term treatment for Craig; and now the law that was suppose to help us is changing for the worse.  Before moving here I literally called every single clinic from Denver to Cheyenne.  After all those hours on the phone, I can tell you with 100% confidence that saying $34,000 a year is equivalent to 4.4 hours per week is inaccurate.

This difference may seem small, but I assure you it's not.  Craig's psychologist prescribes 20 hours of ABA therapy per week.  Up to this point, Bob and I have been making up the difference between this recommendation and what our insurance will pay for by doing the therapy ourselves.  It's not ideal, but it's a close second.

After the changes take place, Bob and I will need to do over 16 hours of therapy a week - OURSELVES.  We've done this before, and I can tell you it's EXHAUSTING (and not quite as effective).  While we're lucky enough to have this option, thousands of families are not:  both parents may work, they may not have the training necessary, or they may have other children to care for. Not to mention, we aren't sure how long Bob and I can keep this up; therapists note that burn-out happens quickly with parents.  Additionally, therapists around the state will lose their jobs as the amount of therapy their clients can receive plummets.

That's why I've decided not to take this lying down; but I'll need YOUR help.  I'm pleading with you to do the following:

1 - SHARE THIS.  Share it with anyone and everyone you know - share it with anyone who will listen.  We need to get this out in the open.  As sad as it is, stories about autistic children losing services don't make the news frequently; I need your help to make this a big deal.

2 - SIGN THIS PETITION.  The Colorado Division of Insurance has openly said, as reported by KOAA, that they will not change the policy unless they hear that people are upset.  Please consider signing even if you don't live in Colorado - chances are you still know a child who will lose services as a result. 

3 - CONTACT THE COLORADO DIVISION OF INSURANCE.  I understand this is a little more time consuming. Write them a letter saying that 4.4 hours of therapy isn't an equivalent to $34,000 per year; tell them that 4.4 hours will hardly make a difference; tell them that they need to raise the limit for 2014.  If you need a form letter, you can find three different options here.  Please email letters to: insurance@dora.state.co.us

4 - CONTACT YOUR LOCAL REPRESENTATIVE (for Colorado residents)
Colorado lawmakers changed the lives of children with Autism once before - and they can do it again.  Write them, tell them that autistic children across Colorado are going to lose vital services, and ask them for help.  Again, I've provided several form letters here.  You can find your local representative here.
I sincerely thank you for your help in this.  I can tell you that these few minutes of your time will make a huge difference not only in my son's life but the live's of thousands of children across Colorado.

10 comments:

  1. I've signed the petition and written a letter - now time to spread the word to others. Good luck, and thanks for letting us get involved.

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    1. Thanks so much Jamie! I really appreciate it!

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  2. Wow I never realized so many paid out of pocket. Our insurance covers most and a state funded program covers the rest for us. We do therapy in home 3xs a week.

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    1. It really does get expensive fast! It's complicated that insurance regulations are SOOOO messy and each state has their own requirements (assuming that state has an Autism Insurance Mandate in the first place).

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  3. Hi Cari.... Maddie emailed me and said you saw my interview on KOAA. I will be present at the DORA meeting on Dec 2nd. I am hoping DORA will increase the limit to a minimum of 1750 sessions per child, which is what $34,000 gave us last year. R. Smith.

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    1. That's what I'm hoping too! I'll be at the meeting as well. I hope to see you at the meeting!

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    2. I forgot to add - thanks for helping bring this to light! Before the story aired, I had NO IDEA that the decision had already been made!

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    4. When I found out I was LIVID and I cried for DAYS. I still get emotional about it because I was in favor of Obama Care. I had cancer and because of it I could never get insured. So I thought, this was such a great thing... but then I realized that our children were slipping through the cracks. I don't care if I have insurance or if I ever go to the doctor, but the thought of not giving my children much needed therapy drives me crazy. Especially when we have scientifically proven treatment for autism.

      The explanation DORA gave in that interview for the conversion was BS and they know it. I am going from 5 days a week, 52 weeks a year worth of therapy to 5.5 months worth of therapy. How is that an accurate conversion?

      I will be there and I will see you there. :o) I am excited. I hope we get to say something and I hope we get the results we need.

      PS. Olivia G. Owens is my pen name. I wrote a book, Sincerely, Michael, which is about my son and what it is like to live with HIS autism. It's not your typical book. :o)

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    5. What's really frustrating is it's actually not ObamaCare - it's how Colorado is interpreting the law. There is a strong legal argument that visit caps actually aren't allowed with the ACA anymore than dollar caps (I'll email you the summary I have on it).

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