Parents, healthcare providers and Georgia lawmakers have called on Amerigroup to reverse a 30 per cent cut to Medicaid-funded autism therapy, warning that the move could leave vulnerable children without vital support.
The demand was made at the state Capitol in Atlanta on Thursday, after the insurer introduced reduced reimbursement rates for applied behaviour analysis (ABA) therapy on 1 September.
Amerigroup provides Medicaid cover for children in foster care and those adopted from foster care. Providers and campaigners say the reduction is making it increasingly difficult for clinics to continue treating children at a time when consistent therapy is considered crucial to their development.
Parents warn of lost progress
Molly Jones, an ABA provider and the mother of a non-speaking autistic child, told the news conference that her daughter Cora had made significant progress through therapy.
“We’ve definitely seen a huge difference in her communication,” Ms Jones said. “She was completely non-speaking when she was first diagnosed with autism.”
She said the lower payments risked creating an unsustainable financial model for providers and could lead to children losing access to services that had helped them develop important skills.
“You spend that much time making meaningful, meaningful steps, and seeing improvements and then to, to see the access kind of get taken away, is a really scary thought,” she said.
State Senator Brian Strickland, a Republican from McDonough who has a child with autism, joined the call for the cuts to be withdrawn. He said Amerigroup’s role in providing care to Georgia’s foster children made the decision particularly concerning.
“Every child with autism needs our support, but it’s especially disturbing that Amerigroup decided to abruptly cut services,” Mr Strickland said.
Amerigroup defends changes to ABA payments
Lawmakers and providers are also calling for Amerigroup to stop removing providers from its network until the state has carried out a full review of whether children can still obtain necessary treatment.
“It is indefensible to cut these rates without at least providing adequate notice and opportunity for the state to review network adequacy for our children served by Medicaid,” Mr Strickland said.
Amerigroup said it had not imposed a blanket reduction across all ABA services. The company said it had rebalanced payments according to the complexity of treatment and the clinical expertise required, in line with a recently released toolkit from the US Centers for Medicare and Medicaid Services.
It said rates for treatment planning and caregiver-engagement services had increased, while some technician-delivered services had been reduced. Payments for services provided by licensed clinicians, it added, had not been cut.
The insurer said the changes applied across its Georgia Medicaid business and were not limited to members of the Georgia Families 360 programme. It maintained that medically necessary autism services remained covered under members’ benefits and applicable clinical requirements.
Amerigroup said members who experienced difficulty accessing ABA therapy could contact its customer services team for help finding available care and maintaining treatment.
State officials are now being pressed to review the availability of providers and determine whether foster children continue to have adequate access to Medicaid-funded autism therapy.
