Public Schools, Private Insurance
September 16, 2008 by Kristina Chew, PhD
Filed under Health
Last week, a bill calling for insurance coverage of autism did not pass the Illinois General Assembly, as reported in the September 12th Daily Journal. An article in today’s Boston Globe looks at recent and ongoing efforts in many US states to get insurance companies to cover treatment for autism, often in the form of Applied Behavior Analysis (ABA). Currently, many families seek ABA and other educational therapies and services from school districts. Noting that some school districts are currently spending more than 20 percent of their budgets exclusively on special ed students, Paul Andrews, director of government services for the Massachusetts Association of School Superintendents, says:
“Special-needs costs have escalated so high that it has reduced the amount of funding we can spend on regular education.”
But having more autism treatments covered by insurance raises other issues, as the Boston Globe notes:
Longtime special education advocates raise another worry: If a private insurer is available to pay the tab for certain therapies, strapped suburban school systems may stop investing in their own programs.
Do you think it’s better in the long run to rely on public schools districts or for private insurance companies for autism treatments?
Reworder:
“Longtime special education advocates raise another worry: If a private SCHOOL is available to pay the tab for certain therapies, strapped suburban school systems may stop investing in their own programs.”
If the advocates are not concerned about that, then why are they concerned about medical insurance?
I’ll go with the title of the Globe article …
“Push on for insurers to share autism costs”
Shouldn’t be an either/or.
What about families without insurance, who have to rely on the public schools for services?
If (big if) the public school’s primary concern is the education of it’s students, then private schools or private insurance should be completely irrelevant to the public school’s actions.
Should be, ideally…….
When you say public school you mean something like the “comprehensive” where I was schooled, when we say public school we mean something like Eton or Harrow.
Interestingly enough I had a conversation with my brother recently and I asked which of the great sixties movies bore a greater relationship to our 60’s comprehensive education, If, or Kess, he said “If” and I think he was right because of the spirit of rebellion we had against the “hidden curriculum” of socialisation to one form of values or another.
I cannot forget the image Malcolm McDowell on the roof of the public school with his Bren gun trained on the Headmaster. (this later inspired Kubrick to cast him as Alex the Droog)
Frankly anyone who wants to impose ABA as the only and one size fits all solution deserves the fate of that headmaster
US–>UK translation
Public school–>Comprehensive school
Private school–>like Eton, Harrow, similar
What would charter school be in this scenario?
Kristina – Massachusetts has an insurance coverage mandate – those in need can get coverage through the state. See link:
http://www.mahealthconnector.org/portal/site/connector/menuitem.d7b34e88a23468a2dbef6f47d7468a0c?fiShown=default
We’re the only state with a coverage mandate like this.
Some school districts in California team up with parents with insurance. The insurance company and the school splits the cost of the ABA (and, likely, other therapies). So, it doesn’t have to be an either/or thing.
@Matt,
How does that “teaming up” occur? Interesting–
I have no idea what a charter school is in UK translation.
What about the quality of these therapies? I have observed that “school” therapies are not always one on one and ongoing; whereas therapies in local rehab hospitals (from my experience) are private and offer more equipment and I think better therapists–at least from my experience.
And, as mentioned earlier, every Massachusetts resident has to have health insurance so this would work very well in MA, not sure if other states are going to follow…?
What about the quality of these therapies?
Matt,
What is your assessment in these education-insurance collaborations? What is the quality? What is the professional oversight? How is quality control maintained?
Without going into a lot of background into why I might be concerned, the worse case scenario that I can imagine of is semi-trained or poorly qualified service providers being able to tap into my insurance plan under a codified system.
Matt:
I am assuming that since insurance will help pay for therapies: not just ABA but all encompassing? Then we will have more choices in the therapist and school?
I have noted from some of my kids’ public school education therapists that these therapists were not always given a lot of room or resources to be creative or as helpful as they would have liked to be–due to money, time constraints, schedules, and the amount of kids needing therapy. I never found the quality of service as “good” as the one on one service that my kids received at private therapy. And that I also knew that my kids were actually receiving these therapies because I was there observing and learning too. I’m not challenging one or the other, just putting it out there as the difference between the two, at least from what I have observed—my kids are 13 and 14 and are both autistic. My daughter goes to NECC as mentioned in the article, and I know the yearly cost of that school—exorbitant, especially residential program, and paid for by our school system because we ran out of less extreme resources.
Our school OT draw a nice, neat line between what she does (”educational therapy”) an what private OTs do (”medical therapy.”) For example, she does not do any sensory integration therapies; she specializes in daily living skills. ABA is considered an “educational therapy” by medical insurance because it is educational in nature. Similarly, it is very difficult to get coverage of speech therapies. OT and PT is easier to get covered, because it is easier to justify as being therapy for medical purpose (gaining use of your hands and body).
In other words, without medicalizing autism, it becomes a learning disorder instead of a medical one, and thus out of the realm of medical insurance. By referring to autism as a medical condition (a disease), you can get medical coverage for treatments.
It is an ugly game of semantics mixed with pass-the-buck.
Our public school system just added an ABA therapist to their staff. I know that, in some cases, ABA is being offered in the school itself. This would be one solution to an either/or situation; if they offer the ABA themselves then they do not need to outsource it.
I agree that it is a semantic issue. Certain therapies like ABA are really more of an educational method than a therapy.
And the cost issue is going to come up again since the insurance companies will try raising their premiums in order to cover the influx of claims.
Then the war will begin about which therapies are considered experimental and, therefore, not eligible to be covered by insurance. This is just the beginning of a whole new debate.
This won’t be resolved for quite a while.
I’ll be the optimist (well, I’ll try to) and note that it’s good that we can have this debate, versus shuttling off kids (am afraid my boy would have been a candidate) to an institution where no one would have tried to teach him anything, or cared to try. One reason my district started their own program was because they figured it would cost less to do it in-district and to do it well instead of going halfway.
ABA is going nowhere, the actuaries of the insurance companies know that, and know that paying for it is a waste of money given the intensity and expense of the product and the low rate of return.
ABA is not educational, nor therapeutic, it is a system, a method, and deeply flawed.
It is a bit like insisting that schools practice dianetic$ in my opinion. You want it, you pay for it. (in more ways than one)
I’d agree that it should be split somehow between insurance and schools, especially for those families who don’t have private insurance in the U.S. Up here (Ontario), we have gotten some of our school-aged therapies through the school, with regular visits from our government funded speech, OT, and behaviour therapists (non-school funded) as well as our case manager etc. It also seems to me that in many cases therapists do different “types” of work, although I find that our outside therapists who go into the kids’ school generally tend to focus more now on “life” things- communication issues, sensory issues etc instead of working on the more “medical” side of things (but that could easily be just my experience with my kids).
Interestingly enough, our schools were ordered to make ABA available in classes as of September 2007, with full coverage in September 2008. Fortunately my kids don’t have to do it, but one of the side-effects has been (in my experience talking to the school boards and the special ed teachers that I know), that it’s seriously hurting the resources available to other children now. The two school boards that I’ve been in over the past 10 years have both always had severely limited funding for both OT and Speech- the therapists are great, but there just aren’t enough of them. Needless to say now that their hours are being cut back even further children are able to be seen even less.
While I do think that schools should be providing what a child needs (that’s why “appropriate education” is important), I do hope that at some point these types of decisions are not made out of political necessity, but rather looking at what really is the best way to provide education for all children. As a taxpayer and parent I’d also have some reservations about paying for non-tested therapies or woo- I’d considerably rather have private insurance pay for chelation or FC or holding or whatever the therapy of the week is rather than having that coming out of my tax dollars.
I did find this quote rather alarming ‘“Special-needs costs have escalated so high that it has reduced the amount of funding we can spend on regular education.” To me that’s a very short step from pitting special education against “typical” education, and I can easily see that happening. There’s enough anger about poor funding for everything in school no matter what children’s needs are that I very much hope that it’s not going to come down to a fight between who “deserves” more money. I’ve already seen it to some extent with some sense of competition between “gifted” and “special education programs” in some areas- let’s hope that won’t become the norm!
what I’ve read of Mass’ mandate scares me. I certainly hope other states don’t go that way.
I do know that MI recently had a bill that was to mandate coverage for autism. I don’t know what happened to it.
I don’t think private schools ability to cover really factor into whether or not the public school will foot the bill, as a vast majority of people with disabled kids do not have the option to send to private schools. Private schools in the US by and large are not set up to handle those with disabilities, even mild ones. There are some areas that are, but not mine.
I know the school can bill medicaid for some of its services. I think if the school could bill the private insurances if a mandate was made, they would be less likely to drop their programs, as they’d be able to get help paying for them.