Providers are raising the alarm about reimbursement rates as some clinics have closed their doors
Tomash said these financial issues have grown into an industry-wide crisis that comes as autism rates across the country rise and the patient base grows. According to the Centers for Disease Control and Prevention, 1 in 36 children nationwide were identified with an autism spectrum disorder in 2020. In 2010, that number was 1 in 68.
BehaviorSpan is financially bad right now, but that means they can’t increase staff to ease workloads or burnout. Employees, not only at BehaviorSpan, but throughout the industry, occasionally leave the field to pursue other behavioral health jobs or even work in retail or restaurants.
Other clinics were not so lucky.
Brian Lopez, founder of the New Mexico-based JumpStart Autism Center, opened a Denver location in 2008. He says that when Medicaid eligibility was expanded through the now-expired public health emergency declaration due to COVID-19, the state did not raise reimbursement rates to compensate for the fact that more families could access autism treatment.
“At the end of the day, we were never able to overcome the challenges of a public health emergency and decided to go ahead and close in the face of diminishing the quality of service we offered,” Lopez said.
Lopez and JumpStart aren’t the only providers pulling out of Colorado. Hopebridge, a company with locations in nearly a dozen states, closed 6 of its 8 locations in Colorado earlier this year, and the CEO blamed the state’s Medicaid rates.
These closures affect remaining suppliers, but in many cases they are unable to accommodate new clientele.
We had an influx on the waiting list of children seen by providers who left the country, and it’s sad because out of a hundred applications that our center receives, I can only serve one child, said Tomas.
For Leitao, what’s happening with pediatric autism care providers seems like a repeat of what happened to adult autism care centers in Colorado years ago, when she first started working in the industry. She used to have adult clients with autism, but the companies stopped providing that service when government funding stopped and only paid for periodic sessions.
Over time, it has become more profitable to work with children than with our adult population, and not just profitable, Leitao said. It’s hard to make a difference or change in an adult’s life when all you do is see them for an hour a week. What will it do?
It is not clear whether the state is ready to provide the amount of money that the providers have requested
At a September hearing before the Joint Budget Committee, Adela Flores-Brennan, director of Medicaid for HCPF, told lawmakers they had heard complaints from providers and would ask the Legislature to raise rates during the upcoming session.
For us, the discussion is how much we can reasonably increase these provider reimbursement rates in the context of other provider rate increases that could be coming, in the context of the overall state budget priorities in partnership with you, when those reimbursement increases might take effect, and what other policy changes we should consider together, she said.
A group appointed by the state legislature, known as the Medicaid Provider Rate Review Advisory Committee, or MPRRAC, advises the state on how Medicaid rates should change. Under its 2023 recommendations for the upcoming legislative budget cycle, Colorado Medicaid pays about 78 percent of the benchmark set by 10 other states for pediatric behavioral health, which includes autism care reimbursements.
MPRRAC recommended that Colorado Medicaid raise rates to meet the benchmark, which would cost about $35 million.
However, the HCPF disagreed. In the same document, they said that including Nebraska in the MPRRAC analysis raised the bar too high, arguing that it was an extreme departure. Without Nebraska, Colorado Medicaid pays about 91 percent of the benchmark and they are willing to meet that benchmark alone, which would cost $13 million, just a third of EM-PRACK’s recommendation.
Former MPPRAC member and disability advocate Maureen Welch said it followed a frustrating pattern she had witnessed during her 2019-2021 term.
“Our recommendations were very rarely reflected in the HCPF Medicaid director’s recommendation,” Welch said.
For now, Colorado autism care centers are waiting until Nov. 20, when HCPF presents its budget request to the Joint Budget Committee, which providers say will show whether their appeals for help have been successful.
This is the first part of a two-part series. The second part will be published on Friday, November 17.
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