They may be giving thanks prematurely, but advocates for autistic children are optimistic that Gov. Brian Sandoval’s next budget will include a major boost for therapy, expanding coverage to include applied behavior analysis, or ABA, a rehabilitative therapy with a record of success.
More than 500 of Nevada’s autistic children are on waiting lists to obtain therapy, and if Sandoval includes a requested $31 million in his budget for ABA therapy in his next two-year budget, Nevada would receive $58 million over two years in federal matching funds for the autism therapy program previously not covered by Medicaid.
Applied behavior analysis therapy takes an early intervention approach. The goal is to change behavior allowing an autistic child to function in school, at home and in the community. The techniques include rewarding positive behavior, timeouts and losing privileges, although it’s not that simple.
In the current budget for fiscal 2014 and 2015, the state allocated nearly $11 million for the Nevada Autistic Treatment Assistance Program, or ATAP, which is fully funded by the state and provides therapy for 381 children.
The numbers show the need is far greater. Education officials estimate that 5,000 Nevada schoolchildren have been diagnosed as autistic. The Centers for Disease Control and Prevention estimate that one out of 68 children has autism.
The governor’s chief of staff, Mike Willden, said the budget will be released Jan. 15, and the autism funding is still being evaluated. So, he cautioned against saying the entire $31 million requested by the agency for ABA therapy is “likely” to be in the governor’s proposed budget.
“We’ve not finished our review of the agency (the Department of Health and Human Services), but I am sure there will be some money for ABA,” he said.
Besides the cost, Willden said another concern is whether the workforce exists to conduct ABA therapy, which involves 25 hours a week of therapy per child.
Despite his cautions, two advocates — Jan Crandy and Barbara Buckley — believe Nevada’s autistic children will benefit because Medicaid recently agreed to cover applied behavior analysis as a rehabilitative therapy, after years of saying no. Four states’ court challenges caused federal officials to agree to cover ABA therapy as a preventive service.
“There is a lot to give thanks for. This is going to save a lot of kids,” said Crandy, who serves on the Nevada Commission on Autism Spectrum Disorders and is the mother of an adult autistic daughter and a recently diagnosed autistic granddaughter.
Autism covers a group of complex brain development disorders, often demonstrated by difficulties including social interaction, verbal and nonverbal communication and repetitive behaviors. Some have extraordinary skills in math, music and art. Think Dustin Hoffman in “Rain Man.”
Crandy is optimistic that Medicaid approval of ABA funding, which she called a “monumental change,” will be added to Sandoval’s proposed budget because it makes sense and because the governor has always supported the needs of autistic children.
Numbers support her optimism. In fiscal 2014 and 2015, the GOP governor recommended more than $2 million over the sum the agency sought. The final funding for the state autism program was nearly $11 million.
Buckley, executive director of the Legal Aid Center of Southern Nevada, supports ABA funding because “there is evidence it works.” In May, she nudged Nevada officials to include money in the budget for ABA therapy, writing to the Department of Health and Human Services and strongly hinting if the money isn’t allocated, her office might sue the state. (The former Assembly speaker knows how to use that big stick President Theodore Roosevelt liked so much.)
The cost of applied behavior analysis services, estimated by Louisiana officials, is $64,000 to $94,000 a year per child. Willden called that a “significant funding challenge” for the budget.
Crandy countered that not treating autistic children “in most cases is giving them a life sentence, robbing them of any chance of independence.”
Therapy can lower the long-term costs. Crandy said when ABA is effective, it allows autistic adults to stay in their family homes instead of living in group homes.
Buckley hopes the state will apply to the federal government in January.
“There could still be obstacles in the way, but it sure looks like autistic kids and their parents will finally have the treatment they need,” Buckley said. “And the ripple effect is huge because if these kids are covered by insurance, those on the waiting list could receive help faster from the autism funding in our state budget.”
There are parents who give thanks if their autistic children do no more than give them a hug or a kiss. Or make it out of a store without screaming uncontrollably. Or speak a clear sentence.
Adding applied behavior analysis therapy to the list of tools possible to help Nevada children, and giving children on waiting lists the opportunity for ABA therapy, would be cause for real thanks for these families.
Jane Ann Morrison’s column appears Thursdays. Email her at email@example.com or leave a message at 702-383-0275. Follow her on Twitter @janeannmorrison.