WHAT'S THE ISSUE? Many parents with children who have developmental disabilities don’t have adequate insurance coverage to cover necessary therapies like speech, physical and occupational. The out-of-pocket cost of said therapies can easily run around $100 per session and most children need 2-4 sessions per week. Some children are not getting the recommended amount of therapy sessions due to the lack of coverage from insurance companies.
HOW DOES IT AFFECT ME? Some families may not be able to afford therapy for their child due to the high out-of-pocket cost and the lack of insurance coverage. It can also sometimes affect schools because sometimes there are the only source of therapy for these children and it can also affect small therapy business owners to succeed because the payout from Medicaid is only $40 per session which doesn’t cover the complete cost of the therapy. Columbia resident Robyn Schelp has pushed for House Bill 1011, which would offer broader health insurance coverage to people with developmental disabilities, to get passed and it will be reviewed by the House Insurance Policy Committee today.
Robyn Schelp’s voice will finally be heard.
After pushing to get better health insurance coverage for those with developmental disabilities and getting two mid-Missouri lawmakers, Rep. Caleb Rowden, R-Columbia, and Rep. Chuck Basye, R-Rocheport, to sponsor House Bill 1011, the Columbia resident got one step closer to what she was looking for.
The bill will be heard by the House Insurance Policy Committee today.
Schelp’s son Nathan was diagnosed with unknown genetic disorder that makes him have skills of someone half his age (he’s currently 9). She wanted to help out other parents in the state who have had trouble paying for out-of-pocket costs for necessary speech, occupational or physical therapies. So she started a coalition to help get a bill passed that would require insurance companies to help cover each therapy session and there would be no limit on how many they could assist with. Therefore, insurance companies would not be able to limit coverage or deny reimbursement for those who are receiving treatment. It also would expand a state treatment program to include developmental, cognitive, emotional and mental disabilities. It would cover both children and adults.
Currently, it is difficult to find insurance plans to cover these therapies, and some cover a certain number of sessions per year, which falls well short of the number recommended of those with disabilities.
“We need to have this for all of our kids,” Schelp said. “There was a bill passed to help those with autism with ABA (applied behavioral analysis) therapy, but what about those with other developmental disabilities. There’s a lot of reasons why that’s wrong. We want to see people with all developmental disabilities and all therapies be covered.”
A local parent, Jacque Arni, has a son with autism. He currently attends school in the Grain Valley School District and has a speech issue. Under her husband’s insurance, a $600 deductible has to be met before the coverage starts kicking in for speech therapy. Zarda said the required amount of ABA therapy for her son is 40 hours per week, which currently is not covered. And no clinic takes Missouri Medicaid insurance because the payout is too low. For speech therapy it’s $60 per session until the deductible is met. The ABA therapy? Well, that’s $200 an hour. In addition to those two therapies, it was recommended by a doctor that he should see an autism specialist once a week, which is not covered by either insurance policy and would be $80 per session in out-of-pocket cost.
“We can’t afford it,” Arni said. “We hope to start him on speech therapy next month, but we wouldn’t be able to afford the amount of therapy he actually needs. They won’t cover the ABA therapy even when I petitioned for it.
“It's frustrating because I know of several people that have moved to Missouri for the Medicaid because it's mandated that ABA therapy is covered by Medicaid, but no provider of ABA that I have found or heard of takes Medicaid.”
Nicole Lindemann, an occupational therapist for Kidz First Therapy in Lee’s Summit said her clinic is unable to take Medicaid.
“We used to take Medicaid, but we lost so much money because the payout was so low,” she said. “We wouldn’t be able to keep the doors open if we kept taking it.”
Another local parent, Brandie (who requested her last name not be used), had a little bit of a different issue. Her son, who currently goes to school in the Oak Grove School District, has ADHD and ODD and had an emergency situation arise that needed immediate attention.
“There were some places that wouldn’t accept his father’s insurance and the places that did had a long waiting list,” Brandie said. “He needed immediate help. We ended up having to take him to White Oak Psychiatric Services and had to pay out of pocket. He then needed therapy; to see a therapist that would cost $50 every week out of pocket in addition to seeing a psychiatrist once a month. So that was $250 per month just to see a therapist and a psychiatrist. The amount of places that was covered by his insurance was very limited.”
These sort of issues are things that Schelp hopes will be alleviated with the new bill, the same kind of issues she used to have with her son. Even currently some of his therapies are not covered.
“Once this bill passes, people will still have to meet their deductible before the insurance kicks in,” Schelp said. “But even when the deductible is met today the insurance still won’t cover some of these therapies. These therapies are easily $100 per session. This bill would have the insurance companies cover the cost when the deductible is met. We want this set in place where no matter what the federal government does, we will have this law set in Missouri.”
Missouri house member Rory Rowland, D-Independence, is a big advocate for the bill and says he will be voting in favor of it once it’s approved by the committee.
“I would like to see something like this done,” said Rowland, who has a son with Down Syndrome. “This would help children with developmental disabilities get the care they need and provide a wider range of services. “Schools provide therapy for those with disabilities enough where they can function in school. Robyn wants to go above and beyond the services of what schools can provide, so they can be ready for life after school.”
Schelp said that the current situation can cause a burden for schools because in some cases, they are the only ones providing therapy for those children. Grain Valley assistant superintendent Brad Welle, said his district has not been burdened by the lack of insurance coverage and the only negative effect that’s occurred is a slight increase in costs to the district’s special education programs.
“The thing about a suburban area district is … in Missouri when the IEP team determines there is a need for that student, we’re required to provide the therapy,” Welle said. “I don’t know that the legislation that is passed would directly affect the school district. I am sure families would be appreciative of the bill.”
Schelp said she it should take about three to four years for the bill to be passed and for it to be signed governor and go into effect. But that process isn’t going to be complete without a few speed bumps.
“It’s going to be a challenge for it to pass,” Rowland said. “You are going to have insurance companies that say that’s not their role or responsibility. You also need the parents to rally around this and say they have a problem, too.”