June 17, 2003

Dear Parent:

As you may know, the state’s current Medicaid coverage of intensive in-home service for children with autism is funded by state and federal dollars. Because of the rapid growth in the number of children receiving these services, the costs associated with the program have increased tremendously. In addition to this, federal officials have raised concerns about whether the program qualifies for federal Medicaid funding as it is currently structured. Governor Jim Doyle asked the Department of Health and Family Services to work with families, providers, legislators and advocates to develop an alternative that would allow Medicaid to continue to receive federal funding and provide coverage for this service.

I am very pleased to be able to inform you that an alternative to the state’s in-home treatment service for children with autism that will qualify for federal funding has been developed and is included in the proposed state budget. We believe that it will allow Wisconsin to remain the center for excellence in the coverage of autism, while assuring that federal financial assistance will continue to be available.

This Department will be submitting a request to the federal government that a waiver be granted to Wisconsin allowing federal funds to be used for coverage of intensive in-home intervention services and a variety of essential support services for children with autism. This waiver alternative reflects not only Wisconsin’s traditional compassion for children, but also reflects the reality of our current fiscal situation. On behalf of Governor Doyle, I would like to thank all involved, including families, providers, advocates, members of the Legislature, and my staff, for their willingness to roll up their sleeves together to develop a workable plan for treatment of children with autism.

Highlights of the Waiver Alternative

Briefly, here are several highlights of the waiver alternative:

• Children up to their 8th birthday, who meet diagnostic criteria, will be able to enroll in intensive in-home autism services.

• The waiver alternative provides treatment at intensive levels (20-35 hours per week) for children for up to a three-year maximum. The funding is adequate to allow approximately 250 new children to enter the program each year.

• To determine whether a new child is eligible for waiver services, we will require an independent evaluation by clinicians experienced in the diagnosis and treatment of autism. Periodic reevaluation during the three years of intensive service will also be required to monitor treatment objectives and progress. This process is currently being developed.

• After children have received three years of intensive services, they will be enrolled in the regular home and community-based waiver services program where they can receive continued in-home autism services as well as other supports and services. These supports and services will be coordinated with relevant services such as public school services, Medicaid card-covered services, and other community-based care.

• In order to help contain the costs of the program, the waiver will also contain a requirement that families with adequate financial resources pay a portion of the program’s costs. The Department is currently working on the details of this with parents, advocates, and counties.

The waiver alternative is projected to begin no later than November 1, 2003. The Department is working closely with counties that, in turn, will locally implement this waiver proposal. Counties are still determining details of implementing this system. Therefore, questions about the waiver should be directed to Beth Wroblewski at wroblbm@DHS.state.wi.us.

To assist in transitioning to the waiver alternative, we will forward your child’s name, your name, and address to your county agency. If you do not want your information forwarded, please let my staff know by completing the attached form by July 15, 2003.

Highlights of the Changes Being Made Until the Waiver is Implemented

Until the waiver alternative is implemented later this fall, the transition plan requires a number of changes to the current way that the service is covered. For dates of service beginning July 1, 2003, the Department will review all children currently receiving intensive, in-home autism services to determine if the child has been receiving the therapy for more than three years. If so, the child will be eligible to receive up to 15 hours per week of transitional services, if appropriate, in addition to other Medicaid-covered services for which the child may be eligible. The 15 hour maximum applies to all face-to-face therapy time but not provider travel time. The mix of various professional level therapy hours will be determined on an individual child basis.

For children who have been in therapy less than three years, the current level of service will be reduced only if the Department determines that a lower number of hours is clinically appropriate under current guidelines and procedures. In either case, if anything changes in regard to your child, you will receive a letter from the Division of Health Care Financing about the specific change.

In closing, I would like you to know how hard so many people have worked to maintain coverage of these vital services. I would like to thank the providers, advocates, legislative staff and Department employees who dedicated so much time to making this change happen. But, most of all, I would like to thank the families of children with autism who took the time and had the courage to help us find new ways to accomplish our common goals.

Sincerely,

Mark B. Moody
Administrator

MBM:my
CH06031.CW

Attachment

Wisconsin.gov