FIGHT FOR ACCESS
Ava Bullard is no stranger to the Georgia Capitol. For seven years, Ava and her mother, Anna, appeared to testify before legislative committees and to lobby the halls. She is the namesake of Ava’s law, which was passed in 2015 and mandates insurance that covers children for treatments related to autism.
“It’s just weird to be here when it’s empty,” Ava said as she walked back down the hallways. Six years have passed. She is no longer a little girl. She is a senior preparing for college. Her mother is standing next to her, beaming with pride.
Her mother recalls when Ava was diagnosed with autism as a toddler.
“She was non-verbal, she had no skills when she was 2.5 years old. No feeding skills, play skills. The shocking part was that none of the doctor-prescribed services were covered by insurance or Medicaid, ”her mother said.
But Ava’s parents knew that intervention at a young age could make a difference. So they ran out of their credit cards. Their families also took part. After a few weeks of Applied Behavioral Analysis, ABA, the progress was evident. Ava spoke her first word.
“I think it was Cheeto. Her therapist said we have to find things that she likes, ”Anna recalls. For the record, Ava still likes Cheetos.
Her family could have moved to a state where ABA therapies were covered by insurance, but Anna said it just didn’t feel right.
“How can I leave this state that I love, my family has always been here. And how can I just go and know that all these kids are not getting any service? So I decided that we’d stay and do Ava Therapy and everyone else go into Therapy because that’s wrong, ”she said.
ABA-trained therapist Lindsie Jones is not surprised by Ava’s story. She says therapy method is an important tool in helping children and their parents find healthy ways of communicating before frustration turns into aggression.
“We are basically in the process of figuring out the function. Why is this person acting the way they do, ”said Jones, who works with teens at Creative Community Services. “Sometimes young people get too big and their aggression becomes dangerous. I think then the parents feel overwhelmed and simply cannot handle it. “
But children with ADHD and PTSD, the main diagnosis of abandoned children, are generally out of the question. Ava’s law only applies to children with autism.
“ABA can help anyone,” Jones said, admitting the risk of abandonment for some of these children is real. She says if therapies like ABA could be used early on in children, not just autistic people, some families would likely stick together.
“That preventative aspect, I hope that one day we can get to this side of the fence and help before parents have to make that decision,” she said.
INSURANCE COVERAGE IS NOT ENOUGH
Even if Georgia expands the services, giving someone access is not enough. There has to be therapists who deliver the service. Because of this, Georgia set a high Medicaid reimbursement rate compared to other states when Ava’s law was passed.
“That brought a lot of vendors here to Georgia,” said Anna Bullard.
It is proof that if you fund a program properly, there will be providers who can carry it out. Child welfare advocates say it is time to take the same approach with other parts of our behavioral health system. And we can’t wait seven years to do it.
“If we don’t address the parity problem, we will continue to fight,” said Gwen Skinner, vice president of operations for Devereux, a mental health community in the metropolitan Atlanta area.
“Devereux serves children with significant emotional disorders,” Skinner said.
It is one of the few institutions in Georgia that works with children struggling with aggressive behavior, another void in our behavioral health care system. Skinner knows the gaps firsthand as well as through her work as Chair of the Georgian Personnel and Systems Development Committee of the Behavioral Health Reform and Innovation Commission, BHRIC.
“It’s not that it’s challenging to work with the population, but that you can recruit and retain the professionals to do it,” Skinner explained. “It’s a specialized service, so you have to accept that it costs more to provide a specialized pathway.”
It may cost more, but she says the state is no longer paying, forcing Devereux and others to take patients from states that reimburse at higher rates. For example, she says Georgia pays about $ 2,850 for a teenager treated in Devereux for a week. Florida pays $ 4,200.
“We’re losing capacity in Georgia. The providers are starting to take in more and more young people from abroad in order to remain financially viable. That means that when the Georgia teenagers have these needs, they have nowhere to go, ”Skinner said.
Access gaps lead to gaps in the workforce. Take child psychologists, for example. It is a specialty, so the training takes longer than that of a pediatrician. That means more debt. However, a 2019 Milliman research report found that Georgia insurance pays 38 percent less for behavioral medicine than medical.
“Becoming a psychiatrist is expensive. But if you choose this professionally, you know you will earn less than if you chose a traditional doctor role. So we know there has to be equality in what the pros make, ”Skinner explained.
The real impact of this pay gap is a shortage of mental health professionals in 150 of our 159 counties, according to a survey by VOICES for Georgia’s Children. 76 of these counties do not have a single full-time psychiatrist or psychologist. Access is being eroded further than BHRIC research shows that only 53 percent of Georgia psychiatrists even accept Medicaid.
The problems facing our workforce extend beyond positions that require a higher education degree. Many families say what they need is simply home support, trained staff who can help with routine care. Getting approval to do this is difficult, getting people to do the job can be more difficult considering they often only pay ten dollars an hour.
“We know you can’t live on ten dollars an hour. And that’s really hard work, ”said Eric Jacobson, executive director of the Georgia Council on Developmental Disabilities. “When we talk about nursing homes getting higher rates or hospitals getting higher rates from the state, they have never brought developmental disability service providers or other home and community-based services into that conversation.”
Because most children who are eligible for these benefits are on Medicaid, the reimbursement rates for these types of benefits are also set by the Department of Health and lawmakers.
Because of this, Skinner took the opportunity to serve at BHRIC.
“My first thought was that I want to be part of it. My second thought was, I hope it will not just be another commission that makes recommendations and does not lead to lasting change for our state. Because that’s where we have to go, ”Skinner recalls.
When asked whether this sustainable change has already taken place, she quickly replied: “No”.
However, Skinner believes the 2022 legislature will bring changes. She says Georgia needs a state care plan that provides a roadmap for care no matter who is the governor or who runs the departments involved.
CHANGE IS POSSIBLE
Anna and Ava warn families to prepare for an argument over money.
“I’ll never forget that one of the lawmakers … looked at me and said this is not personal. And I found it very personal! It’s very, very personal, ”recalls Anna Bullard.
Ava’s Law has increased monthly insurance premiums by 97 cents, according to Georgia’s Insurance Commission. But Ava says look what that dollar did for her.
“I wouldn’t be where I am today at all,” said Ava.
About a toddler who couldn’t talk to a senior at Toombstone High School. Ava is a cheerleader at the top of her class as a dual student in Georgia Southern.
“The answer cannot be how we can just keep throwing money and get more providers. The answer has to be how we focus on making sure the child is getting what science says they should be getting. What results should you expect? ”Said Anna. She believes that if we follow this science, we will see these service gaps and places where providers and insurance companies are not held accountable.
That is now the focus of Anna Bullard’s new fight. She has accepted a position at the Behavioral Health Center of Excellence and this time around the country is committed to ensuring that existing programs use best practice to produce high quality outcomes.
The Bullards hope their story gives some hope that something can change – if you’re ready to fight.
POSSIBLE SOLUTIONS
During this series of investigations, we ask those in the thick of it, “What is a solution?” Here is what they say.
- Increase reimbursement rates for therapists who work non-traditional hours, with children who display aggressive behavior, or in person with children in rural areas.
- Increase the home support reimbursement rate and provide better access if medically necessary.
- Expand coverage and access to ABA therapies to children who might benefit from it, not just those diagnosed with autism.
- Create a loan repayment program for behavioral health professionals willing to work in underserved communities.
- Establish equality in the reimbursement of costs for psychosocial care as medical care.
Ava’s fight for mental health reform
This story was told as part of a 2020 Data Fellowship with the USC Annenberg Center for Health Journalism.
The Reveal is an investigative show that exposes inequality, injustice and incompetence created by rulers across Georgia and across the country.
