For autistic children there is a window of opportunity when behavioral therapy will set them on a path to greater functionality and development. But this proven intervention has been denied to autistic children from needy families in Florida because the state has refused to cover the expense. Last month, U.S. District Judge Joan Lenard of Miami wisely ordered the state's Medicaid program to start paying for these essential services. Under the ruling, poverty will no longer condemn autistic children to more serious cognitive and social problems for life.
The federal trial in Miami was dominated by experts in medicine, autism and child development who testified that a psychological program known as applied behavioral analysis (ABA) is the standard treatment for children with signs of autism, and has been since the 1990s. It was a sharp rebuke to the state Agency for Health Care Administration, which claimed the therapy is experimental and not medically necessary. Lenard was not fooled.
ABA treatment involves intensive personal attention by therapists to reverse a child's declines in language and cognitive and behavioral skills relative to their peers. Studies demonstrate that the therapy often results in significant advancements in intellectual functioning, language development and the acquisition of daily living skills. In young children, particularly before the age of 6, it can make the difference between a child attending mainstream classes or becoming nonfunctioning and losing the opportunity to gain language skills.
State law requires private insurers to cover at least part of the cost of ABA, but state Medicaid had rejected those services for needy families. It is expensive, potentially costing $40,000 or more per year per child. At a time when state lawmakers are increasingly hostile to Medicaid's costs, the extra expense won't be welcome. But the investment is well worth it and will "ultimately save public funds," as Lenard notes. Children who don't receive this therapy are far more likely to become totally dependent on the state or federal government for lifelong care and support. The dollars spent now are a bargain when seen through that lens.
It is disappointing but not surprising that ACHA intends to appeal the ruling. The judge who heard the evidence said getting this therapy to children on Medicaid was imperative to "prevent irreversible harm to these children's health and development." Nothing less than the future of thousands of Florida's needy children is at stake.