Oped: Cutting Medicaid hurts those with autism

Liliane Min, MD and Kate Wallis, MD

The President and Congressional Republicans are again formulating a proposal to overhaul our nation’s healthcare system. While the details of that plan are still uncertain, we must remain vigilant about protecting Medicaid, which has been under attack. We both have personal firsthand experiences with the benefits of Medicaid in helping patients access the care they need. One of us is a developmental pediatrician and the other is also a physician and a parent of a child with Autism. We recognize the havoc that cuts in Medicaid will wreak on the lives of so many families in Pennsylvania, in particular those with children with disabilities and autism spectrum disorder.

Liliane Min

Pennsylvania, to date, has been unique by allowing children with autism spectrum disorder or other severe developmental disorders to qualify for Medicaid (supplemental Medical Assistance), regardless of income, on the basis of their medical diagnoses. This supplemental insurance helps families afford co-pays for medical care, which is crucial because many co-morbid medical conditions affect children with autism. These co-pays can quickly add up as they cover hospitalizations, prescriptions, medical supplies and outpatient visits. But perhaps more importantly, Medical Assistance allows families to access and pay for behavioral supports and behavioral health coverage. Medical Assistance often is the only insurance that will cover therapy services for a child with autism if the primary insurer’s policy excludes or limits behavioral, occupational, speech or physical therapy sessions (as many plans in PA do). Even parents who have a stable and dependable income can find themselves in medical debt, paying thousands of dollars a month for therapy and medical services.

Kate Wallis

While autism is generally considered a lifelong condition, many individuals who carry the diagnosis grow up to lead productive lives. They are able to graduate from college, marry if they choose, and work meaningful jobs. This is our hope for each child diagnosed with autism spectrum disorder. We know that the best outcomes are achievable when children with autism spectrum disorder receive intensive therapies from a young age, especially behavioral therapy. In its current form, Medical Assistance helps children receive these life-altering behavioral therapies.

In addition to giving children the best chances for achievement, early intensive behavioral therapies for children with autism have been shown to have life-long cost-savings. It has been estimated that providing intensive behavioral therapy early in life pays for itself before a child even reaches middle school, and the returns on investment continue annually throughout that child’s life. If Republicans are looking for long-term savings, increasing rather than diminishing access to intensive behavioral therapies makes more sense.

Proposals to replace existing Medicaid models with a block grant program directly threaten the abilities of Pennsylvania families (especially low-income families) to access cost-saving behavioral services. Decreasing the federal contribution to the PA Medicaid system will force cuts to available services and/or to the total number of eligible recipients, affecting families across the state.

Medicaid block grants and per capita caps directly threaten the ability of families to receive needed behavioral supports for their children with autism spectrum disorder and other special healthcare needs. Therefore, it is imperative for Pennsylvania that our elected leaders reject any proposals that would cut Medicaid. Your constituents, including Pennsylvania’s children with autism spectrum disorder, are counting on you.

— Kate Wallis, MD, MPH is a fellow in Developmental-Behavioral Pediatrics, a specialty with expertise in caring for children with developmental disabilities and Autism Spectrum Disorder. Liliane Min MD is a Rheumatologist and the parent of a child with Autism Spectrum Disorder.