I met my patient, a 4 year-old boy with autism spectrum disorder, hydrocephalus, and a genetic syndrome, two years ago. He had recently moved to Philadelphia and was seeking care in the department of developmental-behavioral pediatrics, where I am completing a fellowship. Marcus, as I’ll call him here, had aggressive behaviors and periodically wandered out of his home. His mother works overnight shifts as a home health aide so that she can care for him during the day. But his behavior and wandering were becoming unmanageable for his aging grandmother, who was tasked with keeping him safe at night.
Marcus was covered by Medicaid, so I was able to help his mother find behavioral therapies for him, a home health aide to keep him safe at night, and comprehensive medical care for his complex conditions. Pennsylvania is unique in allowing people with autism spectrum disorder and other developmental problems to qualify for Medicaid or other assistance regardless of income, because the aid they need is simply too costly for all but the wealthiest people. I have seen first-hand how this policy improves the lives of the children and families who are covered.
However, children like Marcus are under attack in the proposed Senate health care bill. Through drastic federal cuts to Medicaid, children with disabilities have a lot to lose under the current Republican proposals.
Though many people don’t realize it, Medicaid helps both poor and middle-class families, covering nearly 1 million children in Pennsylvania. Nearly two-thirds of children who receive Medicaid live in a home with at least one adult who is working full-time.
In Pennsylvania, more than 55,000 children and adults receive services for autism spectrum disorder through Medicaid . They can all be harmed by the proposed cuts to Medicaid.
In addition to Medicaid, Medical Assistance (as a supplemental insurance for children with developmental disabilities) is a program that helps families afford co-pays for medical care for many of the conditions that often come along with autism spectrum disorder.
Perhaps more importantly, Medical Assistance also allows families to access and pay for behavioral therapies. Medical Assistance is often the only insurance that will cover behavioral therapy services, which address the core features of autism spectrum disorder.
We know that behavioral interventions work. While autism is generally considered a life-long condition, many individuals who carry the diagnosis grow up to lead productive lives. The best outcomes are achieved when children with autism spectrum disorder receive intensive therapies from a young age.
These early, intensive behavioral therapies during childhood mean that people can avoid needing intensive ongoing care as adults. So if Republicans are looking for long-term savings, increasing rather than diminishing funding for intensive behavioral therapies makes more sense.
The proposed cuts to Medicaid will also affect schools. Medicaid pays for school-based services for children with disabilities, such as speech, occupational, and physical therapies. Without those critical services, children lose the help they need to succeed in the classroom.
Over the past two years, my patient, Marcus, has made remarkable progress thanks to the services he has received through Medicaid. He is now able to have a conversation, and his behavioral outbursts are much less frequent and less severe. Cutting Medicaid, and imposing per-person limits on spending, as Republicans have proposed, threaten this kind of progress for Marcus and thousands of other Pennsylvania children. Senators, please vote no on any bill that cuts Medicaid. Your constituents, including children with autism spectrum disorder, are counting on you.
Kate Wallis, MD, MPH is a pediatrician in Philadelphia and a fellow in developmental-behavioral pediatrics, a specialty that focuses on caring for children with developmental disabilities and autism spectrum disorder.