Shortage of autism therapists causing billing and insurance issues

Local News

ROCHESTER, N.Y. (WROC) — A new study shows there are not enough therapists to treat children with autism.

Currently one in 59 children are diagnosed with autism — that number is up from one out of every 125 children 10 years ago.

Autism Up says there’s a lack of practitioners who specialize in applied behavioral analysis. It’s an intervention method that they say has proven to be effective among people with autism.

The problem at hand is that a lot of those services can’t be billed through
Medicaid, which means families have to fork out more money.

Danielle Salamone’s eldest daughter, Maddie, has autism.

Her daily treatments in applied behavioral analysis are at the Center for Autism & Related Disorders, or CARD in Fairport. They go once a week because that’s how much they can afford through their insurance provider.

“There is no mechanism for the company to bill Medicaid. So she has a Medicaid secondary, every time we go to CARD. We have a thirty dollar copay. All of it is covered except thirty dollars. If we have to pay seven days a week thirty dollars, four weeks a month, 52 weeks a year, that adds up we can’t do it, ” said Salamone.

According to Salamone, New York State has Medicaid coverage in its budget this year for ABA therapy for kids with autism, but there’s no way for it to be billed.

“Maddie should be able to use this and should be getting the therapy she deserves, but she can’t because there’s no billing mechanism in place, and it seems a little ridiculous,” said Salamone.

Autism Up said that there needs to be structural changes within the state.

“It’s not enough for the state of New York to say, ‘we support you, we know this is a priority.’ Those are just words. We need changes in the budget, and we need changes in those reimbursement rates,” said Director of Education for Autism Up, Rachel Rosner.

Salamone hopes her daughter can go to therapy more than once a week in the near future.

“We are making huge progress with her going once a week. I can’t even imagine the changes in her behaviors that we would see if she was able to get the services she’s supposed to be getting,” said Salamone.

She said the issue goes beyond people with autism and affects people with other developmental disabilities who need ABA therapy. She said she’ll continue work with her congressmen into the next legislative session.

News 8 contacted Medicaid about Salamone’s billing issue and is waiting to hear back.

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