Georgia trims payments for foster children’s autism therapy

Krystina McQueen's severely autistic foster son — who is prone to biting and hitting — has made big strides in his few weeks in specialized behavior therapy. He's in it at the crucial time to learn basic skills, as he's about to turn 3.

But last week the Hall County foster mom got a call from the therapy provider. The business said it may not be able to afford treating him, after Georgia Medicaid abruptly slashed the reimbursement rate by 30% in their policies for foster kids.

Her provider has already stopped accepting new patients at that rate, she was told. Other providers are doing the same, or have even dropped existing patients.

Georgia's Department of Community Health administers the state's Medicaid health insurance programs, and it has put rate decisions for foster children in the hands of the insurance company Amerigroup, an insurer in the Elevance family along with Anthem Blue Cross Blue Shield of Georgia. Georgia outsources its Medicaid insurance work to three insurance companies and has decided for the population of foster children it covers that the contractor will be Amerigroup.

The notice from Amerigroup to clinics said the rate cut is "intended to better align reimbursement across autism services."

In an email from Amerigroup to the state obtained by the Georgia Recorder, Amerigroup said it would raise rates instead for the work that clinicians do training parents on the therapy strategies, calling the new rate structure "a more targeted and clinically defensible approach." Therapy advocates say that training parents and caregivers in the strategies to deal with the child is important but that parents can't take the place of the trained clinicians.

A spokeswoman for Amerigroup said that medically necessary services are still being covered, and that patients should keep up with appointments and follow the treatment.

The state, in a statement from spokeswoman Lauren Williams, said that "in those instances where an in-network provider is not available, Amerigroup is required to secure services with an out-of-network provider" for each individual patient case. Whether patients know to ask for that is an open question; McQueen said she's not heard anything from Amerigroup.

Clinics that provide the therapy that McQueen's foster son was getting, called applied behavior analysis therapy, say that a letter arrived out of the blue in August announcing that the 30% payment cut for the therapy would start Sept. 1.

Dr. Michelle Zeanah, who runs a different clinic across the state in southeast Georgia, had the same reaction as McQueen's therapy providers to the size of the rate cut. She wasn't sure it would really happen so quickly, until last week when her office started getting back the benefit statements for September therapy appointments. The payments were slashed by 30%.

"I can't do that," Zeanah said. "From a business perspective, we'll be too far in the red. I can't do that. And it breaks my heart."

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