Family still waiting for vital therapy for autistic child
S.C. children in need of intensive autism treatment cannot find therapists, and the state's Medicaid agency is to blame, according to a federal lawsuit that alleges the state is driving therapists away by failing to pay them enough.
The lawsuit was filed by Ashley Manley, a Lexington mother whose 6-year-old son has been waiting for more than two years to get more than 40 hours a week of in-home, intensive therapy. A doctor prescribed the therapy for the child after he was diagnosed with Autism Spectrum Disorder.
South Carolina's reimbursement rates for autism therapists are so low that they cannot afford to treat patients covered by Medicaid, the joint federal-state insurance program for the poor and disabled, according to the lawsuit. The suit, filed last week, names the S.C. Department of Health and Human Services and its director, Josh Baker, as defendants.
As a result of those low rates, some S.C. therapists refuse to accept Medicaid patients for the autism treatment, leading to a scarcity of therapists and long waits for their services, the suit alleges.
The lawsuit also says the state is violating federal law by accepting federal Medicaid dollars but not ensuring that children in the autism program have access to treatment they are entitled to under federal law.
The state's failure to provide the therapy to Manley's son and children like him is causing them "irreparable harm," the lawsuit says, estimating there are 1,000 S.C. children with autism who are awaiting therapy.
A spokesperson for the S.C. Department of Health and Human Services said Tuesday the agency does not comment on pending lawsuits.
Manley declined comment Tuesday, referring The State to Toby Ward, her attorney, who is seeking class-action status for the civil rights claim, which has been assigned to U.S. District Judge J. Michelle Childs.
The lawsuit's goal is to get Manley's son, and children like him, the help they need, Ward said.
SC pays the least, autism group says
South Carolina gets money from the federal government to pay for medical services covered by Medicaid. For autism therapy, the state pays 29 percent of the bill while the federal government picks up the rest.
The reimbursement rate that South Carolina pays therapists for autism treatment under Medicaid is the lowest in the nation, according to Autism Speaks, a national autism advocacy group.
Before July 1 of last year, the reimbursement rate for Medicaid-paid autism therapy, set by the state, was $13.58 an hour, including the state's 29 percent share. In July of last year, the state increased that rate to $17.28, less than half of the national average of $48.70 an hour, according to Autism Speaks.
Lawmakers are expected to increase those rates again in the state budget that takes effect July 1, but how much has not been decided.
Manley's lawsuit has the potential to affect hundreds of S.C. children. According to Health and Human Services, there were 1,425 children on Medicaid who had been approved for autism services last June. Of those, 840 were not receiving therapy.
The therapy — called applied behavioral therapy, or ABA therapy — can make the difference between a child with autism growing up to live independently or in an institution, experts say. The therapy helps children with autism and their families develop strategies to correct inappropriate behaviors and regulate impulses.
The therapy can be costly, as it requires a therapist to work several hours a day with a child at home or in school. That time commitment makes it a challenge for parents, including Manley, to afford the therapy without help from Medicaid or high-quality private health insurance, advocates have said.
Without the therapy, the lawsuit says, Manley's son "faces serious harm, including regression of his skills and increases in potentially dangerous behaviors as he approaches adolescence."