The public school enrollment of autistic children, whether born into privileged or impoverished circumstances, has gone from a trickle to a flood. Their legal rights are crashing up against strapped school budgets.
Under two federal laws — the Individuals With Disabilities Education Act and the Rehabilitation Act, both passed in the 1970s and revised over the years — all special-needs children, including those with autism, are entitled to free and appropriate public school educations in the least restrictive environment. And, science shows, the sooner children with autism get treatment, the better their odds of speaking, reading, learning and eventually living independently.
A breakthrough discovery, released Feb. 18 in the online publication of the journal Nature Genetics, could mean that someday medical science might pinpoint the disorder in infancy, or even before birth. Researchers homed in on the genes behind autism, putting an early DNA test within reach.
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There is yet another player in this game: your HMO. HMO’s are loathe to pay for any autism-related service, particularly the most important service, speech and language pathology. In Madison, DeanCare has a history of total denial of claims. Physicians Plus was a bit less stingy, to a point: They would provide speech and other services until a child reached kindergarten, then deny services based on “the MMSD’s legal responsibility once a child enters school.” Even more frustrating was Physicians Plus’ legal maneuvers to avoid parents’ complaints. They would claim they “reinterpreted” policy language to exclude developmental disorders, although they sure covered that same developmental disorder, UNTIL your child reached school age.
In our case, we argued that Autism was both a developmental disorder AND a brain disease and, via many hearings, threats, etc. managed to get Physicians Plus to continue speech and language coverage through first grade. These twice-per-week sessions, coupled with in-school speech therapy 3 times per week, were crucial to our son’s development (an honor student in 7th grade now). When Physicians Plus finally prevailed and we paid for speech out of pocket for about a month until our private therapist could start, the hourly rate for Physicians Plus speech therapy was $175- that was circa 2000.
Even with what I’d consider to be a cadillac state employee health policy with Physicians Plus, they still shoved the costs of Autism right down the MMSD (and taxpayer’s) throats…all the while claiming their City of Madison real property was tax-exempt because they were a non-profit healthcare provider!