Funding Autism Therapy May Slight Other Children

By CATHERINE DOLINSKI The Tampa Tribune

Published: Apr 23, 2008

TALLAHASSEE - Who deserves help the most: low-income children, or wealthier ones who need costly treatment for autism?

That's the kind of Sophie's choice that lawmakers may face when it comes time to vote on expanding health care coverage for children with developmental disorders.

House Speaker Marco Rubio has made a priority of the late-arrived House bill, which would expand KidCare, the state's health plan for low-income children, to cover expensive treatments of developmental disabilities such as autism, cerebral palsy and spina bifida. The bill would also allow more families with incomes too high to qualify for KidCare to buy into the program.

In many cases, early intervention with intense therapies can transform the lives of developmentally disabled children, improving their physical and mental capabilities. But the therapies are expensive - prohibitively so for many families.

The House proposal to provide coverage for those treatments carries a price tag of more than $23 million for the state. So far, though, the only funding that House lawmakers have identified for the initiative is the $36 million they had earmarked to create 38,000 new subsidized KidCare slots for children living under 200 percent of the federal poverty line.

Absent more funding, the House proposal could pit low-income children who qualify for subsidized KidCare slots against wealthier, developmentally disabled ones who seek to buy into the program.

The House, Senate and Gov. Charlie Crist want to remove the state's cap on such full-pay participants, currently set at 10 percent of total enrollment. But although those participants pay the full $110 premium, enrolling more of them will still boost the cost of the program, warned Rich Robleto, director of the Healthy Kids Corp., which administers KidCare.

That's because the new developmental disability coverage would cost up to $36,000 per patient yearly, and up to a lifetime total of $108,000. Normally, Robleto said, covering a child through KidCare costs only about $1,300 a year on average.

"If you raise the cost of the average premium, that's equivalent to using up some of the slots at a lower premium," Robleto said, estimating that the cost of one full-pay child who uses the maximum proposed coverage for a developmental disability would wipe out funding for about 25 subsidized KidCare slots for low-income enrollees.

Choice 'Scares' Lawmaker

The higher premiums would not affect the 1.14 million poorest children in KidCare because they receive coverage for free through Medicaid. But the 230,000 low-income children in KidCare whose families pay subsidized premiums would face the increased cost, making it hard for some to stay enrolled, and fewer available slots, making it hard for others to join.

"When we start going into the KidCare program and having less slots available to cover another portion of our children, which is the children with autism, I have issues with it," said Rep. Rene Garcia, R-Hialeah, who sits on the Healthcare Council that approved the bill Tuesday. "I have concerns because it scares me. It scares me as much as it scares me that children with autism are not getting the coverage that they need and deserve."

Rep. Andy Gardiner, R-Orlando, who chairs the House committee that crafted the bill, acknowledged those challenges but said private insurers would eventually be subject to a state mandate requiring them to provide coverage of developmental disabilities.

The House plan builds on a more modest one from Rep. Ari Porth, D-Coral Springs, and Senate Minority Leader Steve Geller that does not involve KidCare.

Private Coverage Rule Proposed

Geller's bill, which is headed for a vote in the full Senate, mandates only private health insurance coverage of treatment of autism. On Tuesday, Geller said he applauds the House's efforts to expand coverage to more kinds of developmental disabilities. But he is concerned, he said, about the cost and its impact on the rest of KidCare. Geller hopes, he said, that lawmakers will pass his bill this year and revisit the issue.

On Monday, Rubio, R-West Miami, assured Gardiner's committee on autism that the proposal had his full backing, even as both chambers are negotiating as much as $1.2 billion in cuts to the state health care budget.

Lawmakers and political observers speculated on Tuesday that the speaker might dig into state reserves to fund his developmental disabilities initiative.

On Tuesday, Rep. Loranne Ausley, D-Tallahassee, said House leaders have expressed their commitment to the proposal; now it's their responsibility to fund it, she said.

"Marco Rubio stood in front of us for the second time and said, 'Do not let time or money stand in the way of doing the right thing,'" she said. "But the right thing has to be for all children, and the KidCare program is for all children."

Reporter Catherine Dolinski can be reached at (850) 222-8382.