Updated Mar 06, 2019; Posted May 03, 2017
Special education experts contend that behavior therapy for children with autism, the subject of a political fight in Montgomery, could have beneficial effects beyond the individual student and could help Alabama catch up with other Southern states.
"Kids with autism in Alabama enter kindergarten at a disadvantage when compared to neighboring states including Georgia, Florida, and Mississippi,"
said Dr. Bama Hager, program director for the Autism Society of Alabama and parent of a child with autism. Hager said that is due to the lack of accessibility to Applied Behavior Analysis, or ABA, therapy for children with autism. A bill stalled in the Legislature would require private insurers to cover the costs of behavioral therapy for children with autism. Opponents of the bill include Blue Cross and Blue Shield of Alabama and the Business Council of Alabama. When asked whether public schools should be shouldering the cost of ABA therapy, Blue Cross and Blue Shield of Alabama spokesperson Koko Mackin, in a statement to AL.com, said, "The public school system is appropriately supported by the taxes paid by individuals and employers, such as Blue Cross. Whether or not public schools have sufficient revenue is a policy issue best determined by state government." Forty-five other states mandate insurance coverage for ABA therapy, according to Autism Speaks. Alabama, along with Idaho, Wyoming, North Dakota, and Tennessee, have no mandate.
James Gallini, an attorney specializing in special education and civil rights cases, said correcting problem behaviors of a child with autism has a "trickling over" effect, positively impacting not only the child with autism, but also the child's classmates and teachers. If the behaviors of one child are improved, "that could impact fifteen students on a daily basis," Gallini said. Gallini estimates he has filed hundreds of complaints against public schools on behalf of students since starting his law practice in 2009. In his Alabama practice, he said it's likely he has filed complaints in three out of four of Alabama's 137 school districts. In about 80 percent of those cases, ABA becomes a part of the solution reached in the settlement with school officials, he said. In many cases, schools agree to pay the cost of attorney's fees as part of a settlement. Dr. Eric Mackey, executive director of the School Superintendents of Alabama, said his organization supports HB284. "As educators, our first priority is always to help create better outcomes for children," Mackey said. "If ABA can lead to better outcomes for children in school and, thus, to better achievement as adults, then it has value as an investment for private insurers." Another problem school budgets face it that Alabama's Medicaid agency isn't currently covering ABA therapy, even though federal law requires it, leaving schools to cover the cost for those children as well. Alabama officials are in settlement negotiations right now to fend off a lawsuit from two advocacy groups demanding Alabama Medicaid cover ABA therapy.
Mackey said he doesn't know how much money schools are spending on ABA therapy. As for the individual child, the timing of the intervention is important, as problem behaviors can more easily be corrected when children are younger, said Ashlie Walker. Walker is a behavioral analyst whose company, Milestone Behavior Group, contracts with 32 school districts across the state to provide services including ABA therapy, for students with autism. However, unless the child attends a public preschool, they likely don't have access to behavior assessment and ABA services until they are identified for special education, which can happen in kindergarten, particularly for children with autism. "Our work is really cut out for us" when children are older and maladaptive behaviors such as hitting or self-injuring are more entrenched, said Walker. "It takes us longer to be more successful with older kids, and older kids take more money," costing schools even more, she said. Walker said that schools are footing the cost and she estimates that school-based services make up 70 percent of her business statewide. She said more than 50 percent of her clients come to her as a result of the settling parental complaints. The process of filing a complaint often starts out in a negative way, said Gallini, but added: "The outcomes are overwhelmingly positive, not only for the education systems, but also for the child. Because we go in and we problem solve." Gallini said "some of the systems simply don't have the resources" to afford ABA and other services to properly educate a child with autism. Mackey said schools are struggling with the cost of special education, as costs are increasing exponentially. Gallini, Walker, and Hager have all been active in the fight to win passage for HB284, a bill requiring private insurers to cover ABA. HB284 passed out of the House with a 100 to 0 vote, but initially stalled in the Senate. On Tuesday, Sen. Trip Pittman, R-Montrose, moved the public hearing for the bill to May 4 because of interest in the bill, he said. Pittman said the vote will be held on May 10. The lack of reliable data on current costs within the public schools is a problem. Without reliable cost information, it's unclear how much school budgets stand to gain if the cost to provide ABA therapy shifts to insurance providers and on to those paying premiums. The cost of providing insurance coverage for all is a concern for the Business Council of Alabama, which opposes HB284. In a statement to AL.com, BCA president and CEO William J. Canary said, "The BCA believes this bill remains an expensive mandate on both public and private health plans and it lacks accurate information on the costs imposed on Alabama businesses and their employees who will ultimately be the ones to pay for this new government-mandated benefit." Responding to a question about why this particular benefit is one Blue Cross has chosen to oppose, Mackin at Blue Cross said, "Opposition to legislated mandated benefits has been a longstanding position of Blue Cross on behalf of our customers. We certainly are not opposed to the treatment of autism, but we are definitely opposed to the legislature requiring that all consumers be required to include benefits that they don't want, may not be able to afford and can't access." Gallini said ABA therapy, started early, makes all the difference in the trajectory of the life and education of a child with autism. "We're going to reduce the number of classroom issues, reduce the number of kids that require adult support in the form of an aide, take pressure off the number of kids that need self-contained or small group settings," said Gallini. Mackey cautioned that while research is still emerging on the therapy's benefits, "ABA therapy holds a lot of promise for limiting -- maybe even eliminating -- the level of services students will require once they get into school and, for that matter, for their entire adult lives."