Applied Behavior Analysis Therapy: Military Families Struggle With Tricare Autism Insurance Coverage Changes

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FAYETTEVILLE, NC (WTVD) – The concerns expressed by some families in Fayetteville in the spring have now become a reality.

“When I heard that they were taking ABA out of school, I literally had a stomach ache. It was a devastating blow because, for my daughter to get the education she deserves and that she deserves. is able to get, she needs her RBT, ”Fayetteville’s mother Katrina Powers said in May.

RBTs or behavior therapists work with people with autism.

Tricare, the U.S. Department of Defense health care program, added limitations and restrictions to Applied Behavior Analysis (ABA) therapy, particularly in schools and community settings in May.

Powers was one of the parents who voiced concerns about the changes that would impact her daughter’s education.

Her daughter, Teagyn, attended school alongside her ABA therapist, Gabby, for three years.

“Gabby was providing support in all aspects, academic, social, personal hygiene. I mean just everything; not that Teagan can’t do it, but she needs reminders. She needs someone all the time. with her to keep her at work, ”Powers said.

Powers said the support made a big difference and that she saw her daughter’s academic performance improve.

However, due to the changes to the Tricare coverage, Teagyn started this school year alone.

“Besides being very hard on her mentally and emotionally, we also don’t get therapy because Teagyn’s day is so long. Doable,” Powers said.

She said that during the first few weeks of school she noticed a difference.

Teagyn attends the School of Hope in Fayetteville. The private school welcomes autistic students. Many students can only attend if they are accompanied by an ABA therapist throughout the day.

Hope School principal Amy Sparks said some families have had to drop out of school and some have not even been able to enroll due to Tricare’s coverage changes.

“When I’ve had parents come into my office and have to tell them that you know they have to have RBT for safety reasons. I can see the impact in their eyes. I have to be the one. who saw this crying mother telling me, ‘Amy, that was our last hope,’ “Sparks said.

Many students who attend the School of Hope have tried public school and were unsuccessful.

Teagyn was able to stay in private school without his therapist, but Sparks said the experience was different.

“It definitely has an impact on their education. When you have to redirect a kid, you know, 25 times in a minute, you know, you have to think about the teaching that’s actually going on,” Sparks said.

In the classroom, the RBTs provide this one-on-one support.

Tricare still allows individuals to receive ABA therapy, but in a more limited capacity and not for the duration of the school day. Without insurance, families said help would cost more than $ 6,000 per month.

Sparks called the changes a shame on the country’s military families.

“I think we need to control our priorities. What’s really important? Is it really our kids, or is it about the money?” Sparks questioned.

In May, a spokesperson for Tricare said the changes were made after three years of working with industry stakeholders and lessons learned.

“Although this is a new requirement that came into effect on May 1, 2021, there was never any question of reimbursing non-clinical or educational services. School services, where BTs serve as academic support. , shadows or aids are beyond the scope of ABA Services covered by the ACD. The ACD is authorized to reimburse the active provision of ABA services. BTs authorized by Tricare in the school setting do not provide actively serving ABA, ”wrote a spokesperson in an email.

North Carolina lawmakers said they continue to hear concerns from families.

US Senator Thom Tillis’s office said Tillis was working with his colleagues to improve Tricare’s ABA therapy for military children.

“Senator Tillis is a strong supporter of military families and will continue to work with his colleagues to champion their cause to ensure that appropriate medical services are available for children with special needs,” wrote Lauren Scott, press secretary. de Tillis in an email.

Likewise, the office of US Representative Richard Hudson has said it is committed to strengthening the program. Hudson recently worked to include a study of the program in this year’s National Defense Bill. The study would examine the impact of the program and include direct feedback from parents and stakeholders, according to Greg Steele, spokesperson for Hudson.

“It is the congressman’s goal that this report is essential to enable the necessary improvements to the program,” Steele wrote.

In the meantime, parents like Powers hope their children don’t suffer.

“I just don’t understand why this happened or where they get their information from, because if they were actually listening to the people who are at the heart of the action, it affects our lives every day. don’t see how they could do this to us, “Powers said. “I don’t know. I don’t know what to do.”

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