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The CWA Waiver Expansion Was Denied…Now What?

By: Carol Meredith, Executive Director

Did You Know ConceptParents of young children with autism spectrum disorder in Colorado have been anxiously waiting to hear about when they could start getting services for their children under the expanded waiver that was passed by our legislature effective July, 2015. The Children With Autism (CWA) waiver is part of the Medicaid program, and Medicaid is funded (about 50/50) by the state and the feds. So, when we change a waiver we have to get approval from the Centers for Medicare and Medicaid Services (CMS -the feds).

On September 14, CMS made their decision– they said “no” to the expansion and required Colorado to cover these services under regular Medicaid/Early and Periodic Screening, Diagnostic and Treatment benefit (not a waiver).

The decision by CMS to deny the CWA expansion is good news/bad news. Many advocates and parents have said for YEARS that behavioral services for children should be covered under regular Medicaid. For children with autism and other neuro-developmental disabilities, we have argued that this intervention is “medically necessary”. So we have finally won that argument, but what does that mean?

Our state Medicaid agency sent out letters in the mail about the decision. We have given them feedback that these letters aren’t very helpful and have volunteered to help them craft something that is more beneficial to families.

We have learned that there is only ONE PROVIDER in the state right now that can bill for these services. The problem is that they just received the decision and adding a service to our Medicaid program will not be like flipping a switch. Medicaid is public insurance, so the public gets to have a voice. Which means this is going to be messy for a while.

We know that every day in a young child’s developmental life matters. We want you to know that our staff and others are pushing and prodding the state to move the process along – quickly. We will be at every meeting and keep you informed as to next steps.

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You can help make this a priority for the state by calling the numbers on their letters for more information.

Ask: Who is a “qualified provider” that can start the process of getting my child services?
Ask: When will there be a provider in my area that I can talk to?
Explain: My child needs services now.

In the meantime, keep doing what you are doing. Get everything you can from other programs like Early Intervention, school district services, private insurance and Medicaid. Even if Medicaid is your only resource, there are speech therapists and occupational therapists that really understand children with behavioral disorders. These services do not have limits or caps.

Currently, the ONE PROVIDER in the state that can bill for these services is Professional Pediatric Home Care.   Please call Jennifer Rahrer  at 303-747-4021 with inquires and assume that it may take some time to get your questions answered as there are a lot of children who need these services.

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