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reprint or license thisMedicaid won’t fund S.C. autism program
Loss of money puts S.C. schools serving children with brain disorder ‘in a real bind’
By DEVON MARROW
dmarrow@thestate.com
S.C. school districts will lose about $1.4 million in federal Medicaid funding to teach autistic children as of Dec. 31.
The state Department of Health and Human Services, which oversees the state’s Medicaid plan, will pull $700,000 from its $944 million annual budget to fund the services through the end of the school year.
Districts will receive word about the HHS funding early next week.
But it is unclear how schools will find the $1.4 million annually to teach those nearly 3,000 autistic students after June.
“Schools are in a real bind,” said Craig Stoxen, president of the S.C. Autism Society. “They can’t say, ‘We can’t bill Medicaid, so we can’t offer the services.’”
About 40 districts — including five in the Midlands — are reimbursed by Medicaid for applied behavioral therapy, which is an intensive therapy that breaks learning down into tasks.
The child’s completion of a task is rewarded.
Autism is a brain disorder that often interferes with a person’s ability to communicate with and relate to others. Symptoms include problems developing nonverbal communication skills, such as eye-to-eye gazing, facial expressions and body posture.
Stoxen said early intervention is key to the children having a successful future.
“Do we pay more now, or do we pay more later? You’ll be an adult a lot longer than you’re a child.”
POSITIVE EFFECTS OF THERAPY
Three years ago, Carmen and Raymond Brennan knew something was wrong with their daughter.
Tiana could not walk, didn’t recognize her parents and screamed at the slightest change in routine.
She struggled to develop such basic functions as speaking.
“I couldn’t even potty-train her. She was just lost. Gone,” Carmen Brennan said.
But when she and her husband found out about Clarendon 2’s program and its use of applied behavioral therapy, the family decided to make the move from Oklahoma to Manning.
Now 5 years old, Tiana attends Manning Early Childhood Center. Her day is broken into a series of 30-minute intervals split between her class and her therapist.
Carmen Brennan said the program has made all the difference.
“She understands what we’re saying to her. She understands who is her mom and dad.”
It’s important, Brennan said, that people recognize the positive effects of the therapy.
“These kids have medical injuries. They have brain problems. (Therapy) is rehabilitating them.”
‘YOU CAN’T DO THAT WITH THEM’
School officials praised the Health and Human Services Department’s decision to temporarily fund the initiative.
“I applaud (the department’s) efforts and their commitment to school-based programming,” said Virgie Chambers, director for the state Education Department Office of School-based Health Finance.
But she cautioned that school officials and the state department have yet to outline a long-term plan.
In the memo the department sent out in late September, state and district officials learned that applied behavioral therapy no longer would be reimbursed by Medicaid because the program:
• Teaches new skills instead of reteaching lost skills
• Is limited to children with autism
• Is only offered in schools
The letter suggested the schools seek funding under the federal Individuals with Disabilities Education Improvement Act. But educators said that funding was not enough to cover the programs.
“If that funding wasn’t suffering in the beginning, we would never have sought additional funding,” said Barbara Drayton, of the state Education Department.
Under IDEA, the federal government can fund up to 40 cents for every extra dollar a district spends on autism programs above the base student cost. So, if it costs $1,000 to educate a nondisabled student and $2,000 to educate a disabled student, the federal government would pay $400 of the additional costs.
Currently, officials said, the federal government pays 19 cents per dollar.
That’s not enough, said Elease Fulton, Clarendon 2’s director of special services.
“Our program really depends on the funding of Medicaid,” she said. “The money we get in our budget is not enough.”
In fiscal year 2005-06, the rural district received nearly $189,000 from Medicaid to fund its applied behavioral therapy program, the largest payout in the state.
Clarendon 2’s 10-year-old program has garnered a reputation of excellence through word of mouth and a partnership with a for-profit organization, the S.C. Early Autism Project.
The district offers 15 students intensive therapy and individual attention. Each child is assigned a full-time aide, who works to establish communication and socialization skills.
But not just children with autism benefit from applied behavioral therapy, school officials said.
Kershaw County, which received about $37,000 in federal funds last year, offers the therapy techniques for students who don’t have autism. Schools also use the behavioral therapy with children with social and behavioral problems.
The district serves 43 students with autism, 35 of whom qualified for Medicaid.
Chambers said the state is willing to open up the programs to all students and change goals to maintain the Medicaid funding.
“If that is a deterrent,” she said, “by all means remove those restrictions.”
Parents like Brennan said they are worried about the future of their children’s therapy.
“I think the school system is strapped as it is. What they’re going to do is cut corners,” she said.
“These children — you can’t do that with them.”
But school districts legally must provide certain services under IDEA, leaving them with one option: Get creative.
In Clarendon, Fulton said, the district will start identifying available grants.
“We have to provide for the child’s need whether the child happens to be disabled or not. In essence, we’re going to really have to go to the drawing board.”
Reach Marrow at (803) 771-8485.
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