Poor children deserve equal care

03 Apr 2012 9:54 AM | Anonymous
The Miami Herald Editorial 

When Florida and many other states began to close institutions for people with mental and developmental disorders 50 years ago, they held out great hope for families. In place of those dreary places, these vulnerable and their families would be supported by an array of services in the community. In all this sweeping change was promised to be better for families - and cheaper for taxpayers.

This promise for families has hardly been fulfilled. For many states, cheaper trumps better. And being cheap continues to reap an expensive stream of lawsuits over the corner-cutting.

The latest example came this week in a ruling from U.S. District Judge Joan Lenard. In a decision sizzling with outrage, she ordered that Florida provide the same opportunities for help to autistic children covered by Medicaid as its own Legislature has required for children covered by private insurance.

The state agency administering Medicaid argued that the type of behavioral therapy required to be offered to children covered by private insurance is too "experimental" for poor kids. That's despite its wide acceptance and that state mandate for other families. Although this type of behavioral therapy may not be beneficial for all children with autism, it has been found by most (but not all) researchers to be a major tool for early intervention with young children.

In too-brief a thumbnail description, children with this neurological disorder work intensively with a trained therapist to short-circuit behavior such as tantrums, to develop language skills and to understand and complete tasks. The goal is to promote normal behavior and move as close to independence as possible.

Judge Lenard heard expert testimony that the therapy has resulted in South Florida children being able to attend mainstream classes while those who do not get help languish.

In other words, not providing early, intense intervention is penny wise but damaging in both the short and long term.

Her ruling may affect other states with the same disparity between mandated private coverage and no coverage under Medicaid. It should be no surprise that states would tolerate the disparity. As with many other mandated coverages, the private-insurer mandate sprang from concerted lobbying efforts by families devastated by the cost of an illness excluded from their policies.

Insurance companies have a history of excluding or limiting coverage for mental or developmental conditions. Part of that is fear of high, endless coverage. Part of it (and government's failure to aid poor families with these conditions) seems to spring from stigma afflicting people with mental illness and disability.

Lawmakers should not insist the private carriers or Medicaid pay for every new therapy that its proponents believe in. But here no one is asking Medicaid to provide gold-plated coverage when legislators, and now a judge, are sufficiently convinced to require it for other Florida families.

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