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An Opportunity

July 21st, 2015 at 05:56 pm

Most of you know that we adopted two boys, both of whom fall into the autism spectrum. They've been getting ABA treatment most of the time for the past 1.5 years. ABA is "Applied Behavioral Analysis", which is the gold standard in autism treatment. We started out with our local community mental health, which is 25 miles away. About 10 months ago, a local ABA treatment facility (6 miles away) opened up. We were able to get DS1 started in January, and DS2 about a month ago.

The CMH option was free - both boys are Medicaid eligible since they were adopted from foster care. The "costs" were the time and expense of driving them 25 miles, and the quality of treatment was inferior to the local clinic. Plus, DS1 aged out of Medicaid ABA when he turned 6 last year. Although the policy has changed since then, and he would be covered through age 18 now.

The local clinic is covered by my insurance. But, there is a $20 co-pay - each visit. We did not do our due diligence, and we were not aware of the $20 co-pay until recently. We did get a bill about a month ago. We called the billing service, and asked that they submit the bill to DS1's Medicaid coverage. We've not heard back about that, but we have since found out that on our own that Medicaid will not cover the co-pay. So, now with both boys enrolled, we owe the local clinic about $3,000.

Last week DW and I had a meeting with the tow directors of the ABA center. They asked us if we would consider pulling DS2 out of his special ed. preschool program, and start him 35 hours a week at with the ABA program. He's 5, so not yet at mandatory school age. During the conversation, DW and I brought up the possibility of doing the same thing with DS1 - pull him out of his special ed. program, declare that he would be home schooled, and enroll him 35 hours a week in ABA treatment.

The benefits of ABA are clear, and undeniable. The benefits of the special ed. program, not so much. ABA offers one-on-one interaction with a specialist trained in working with autistic kids. The special ed. program might include kids with Downs Syndrome, and other conditions. DS1 is (usually) quiet, and will melt into the back ground. DW and I have both observed the special ed. class room, and we both noticed the teacher and her assistants would sort of let DS1 alone, and attend to the other children. The squeaky wheel gets the grease! The ABA techs force interaction from the child. ABA is clearly doing more good for both boys, and the local clinic is clearly superior to the community mental health option.

And, I suppose it follows that it would be the more expensive option.

We verified that it is our responsibility to pay the $20 co-pay (whether they are getting 20 hours of service over 5 days or 35 hours of service over 5 days, $20 per boy per visit) while we were researching the reality of pulling them out of school.

So, we owe $3,000 for prior treatment, and we will owe for any future treatment.

It comes out to about $12,000 per year.

The boys need this treatment. It improves their lives. It improves our lives. It improves our daughters lives.

But, it's going to be expensive.

There is a possibility. There is another supplemental medical coverage that both received when they were adopted. We've not had to use it yet, because all of their medical expenses have been covered through my private insurance or Medicaid or a combination of both. This supplemental coverage covers anything that is not covered by insurance or Medicaid, as long as the condition was present prior to adoption. Their autism was present prior to the adoptions.

DS2 is probably all set. DS1 is not. We dropped that supplemental coverage for him a couple months ago.

Why would we do that???

The state of Michigan offers a monthly $220 autism supplement. He was not eligible for the autism supplement if he was enrolled in the other supplemental medical coverage. Our thinking was "We've had this supplemental coverage for three years. We've not used it once. Monthly payments of $220 will almost certainly come out ahead, right?"

I guess not.

DW is now figuring out how to get DS2's supplemental coverage to cover the $20 co-pay, and is figuring out how to stop the $220 monthly autism supplement, and how to get DS1 back on to the supplemental coverage.

I'm fairly confident that at some point in the not so distant future that both boys will be covered, and we won't have to pay the $12,000 per year.

I also know that we do owe the $3,000 for previous treatment. And, prior experience tells us it will be three, four, or five months before both boys are covered by the supplemental medical coverage. So, we'll owe for treatment for at least one boy during that time.

But, we are pulling them out of their special ed. programs, and starting 35 hours weekly of ABA for each boy. That was the best decision.

4 Responses to “An Opportunity”

  1. SecretarySaving Says:

    Bob- Do you the boys have friends in there class that they would miss? HAve you talked to the person in charge of the spec ed program for the school and district to see what there plans are for the program and ask if there are any other resources that the district provides or that the government provides that they know of. Parent participation is huge. My mom works with spec ed. In the summer she was part of a government program where she went into the home for 2hrs and gave 1v1 attention to the kids and helped them learn daily routine things, ie brushing teeth, etc. while the parents are in the home. She was paid $25/hr but it was free to parents and that is in the state of Texas. Not sure if Michigan has that program but it would be good to look into it and see.

    Could the ABA use the documentation and progress of the boys for publication to promote the center and in exchange wave the fee? Do they have a scholarship program? Is there any classes that could be provided to the family so that you can work with the boys on what they would do at the center?

  2. LivingAlmostLarge Says:

    Often the clinic will help you maneuver the system. Can you explain the situation and say you need help. I feel like people doing that sort of work for a reason. I think your plan is sound because it does sound liek specialized home schooling.

  3. Bob B. Says:

    Great idea LAL. One thing I forgot to mention yesterday is that we do get $1,000 adoption subsidy per month for each boy. It's their money,

  4. SecretarySaving Says:

    Bob you are a good man.

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