Regulators of Florida healthcare have left children with autism from impoverished families at risk of “irreversible” harm by refusing to pay for a critical therapy that can help them lead more normal lives, a Miami federal judge has ruled.
U.S. District Judge Joan Lenard said in her 16 years on the bench, the case “if not the most important, is one of the most important cases that I have ever heard. Judge Lenard in an order signed this week, required the state’s Medicaid insurance program for needy families to start funding a psychological program, called applied behavioral analysis, designed to improve the behavior, language and cognitive development of autistic children. Commercial carriers are already required by the state to provide the therapy, also called ABA, to Floridians with private insurance — meaning children from poor families were being denied services wealthy children has access to.
Lenard ruled the plaintiffs had established that “there exists in the scientific and medical peer-reviewed literature a plethora of meta-analyses, studies and articles that clearly establish ABA as an effective and significant treatment to prevent disability and to restore children to their best possible functional level and restore their developmental skills.”
“It is imperative,” the judge wrote, “that autistic children in Florida receive [behavioral therapy] immediately to prevent irreversible harm to these children’s health and development.”
Shema Kolainu – Hear Our Voices uses Applied Behavior Therapy as our primary therapy and over the years have seen many drastic improvements in our students.
ABA methods are used to support persons with autism in at least six ways:
- to increase behaviors (eg reinforcement procedures increase on-task behavior, or social interactions);
- to teach new skills (eg, systematic instruction and reinforcement procedures teach functional life skills, communication skills, or social skills);
- to maintain behaviors (eg, teaching self control and self-monitoring procedures to maintain and generalize job-related social skills);
- to generalize or to transfer behavior from one situation or response to another (eg, from completing assignments in the resource room to performing as well in the mainstream classroom);
- to restrict or narrow conditions under which interfering behaviors occur (eg, modifying the learning environment); and
- to reduce interfering behaviors (eg, self injury or stereotypy).
The judge rebuked the Florida Medicaid agency – the Agency for Health Care Administration – for failing to properly examine the evidence underlying ABA and for taking so long to address the issue. “How many children were lost?” the judge asked.
Although the ruling currently impacts only Florida, it could have major implications for other states, many of whom don’t provide coverage for the therapy through their insurance for the poor.
“The case will have national impact because while most states mandate that private insurance companies must cover ABA, most state Medicaid programs do not provide coverage, said Miriam Harmatz, a senior attorney with Legal Services of Greater Miami, which filed the suit. “Judge Lenard’s order eliminates this tragic disparity.”
In testimony at the trial, Dr. Elza Vasconcellos, a neurologist who is director of the Autism Clinic at Miami Children’s Hospital who treats two of the children at the center of the case, said children who receive the intensive psychological therapy often were able to attend mainstream classes with their typically developing peers.
“I see kids who get applied behavior analysis and have money getting better, and kids who don’t have money just staying there — and we don’t see any progress,” Vasconcellos testified. “For me, as a mother and as a doctor, it’s really devastating to see that.”