BAKERSFIELD, Calif. (KERO) — Administrative changes to the review process for autism therapy at Kern Health Systems are raising concerns among families who say treatment delays could lead to developmental regression in their children.
Kern Health Systems, which manages Medi-Cal benefits for Kern County residents, says it is working with families and providers to ensure care continues. But parents and advocates argue recent changes have resulted in widespread denials of Applied Behavior Analysis, or ABA, therapy — a treatment widely used for children with autism.
Seven-year-old Elizah Sanders is one of the children affected.
“Eliza is what they consider a level two autistic. She is mild to moderate,” her mother, Summer Walker, said.
For more than a year, Elizah received ABA therapy in her home, about 30 hours a week. Walker said the services helped her daughter regulate emotions, build life skills and follow daily routines.
“It’s been life-changing for us,” Walker said. “They’ve provided so much support and structure and growth opportunities that she would have never had without ABA services.”
That changed about a month ago, Walker said, when Elizah’s services were denied twice.
“So we’ve been denied twice in the last month, the first time because they changed their process of getting approved,” Walker said.
Advocates say Walker’s experience reflects a broader pattern following changes to Kern Health Systems’ review process, which is now handled by outside contractor Allmed Health.
According to the Autism Business Association, the shift has led to a surge in denials for autism services.
“While denials are typically rare, since September, Kern Family Health Care is now denying or delaying around 79% of our cases,” said Natalie Arrache with the Center for Autism and Related Disorders.
Arrache said that since September, only five of 24 treatment plans submitted by her organization were approved.
Families, ABA providers and case managers raised concerns during a Kern Health Systems board meeting on Dec. 18, saying denials often cited missing information that was already included in applications.
Kern Health Systems CEO Emily Duran said during the meeting some requests did not meet medical necessity requirements.
“We are highly regulated by the Department of Health Care Services,” Duran said. “Yes, we have seen that there are some denials, but when we dig deeper into the authorization process, out of medical necessity, unfortunately some of that was not present.”
In a statement, Kern Family Health Care said it is committed to ensuring members receive appropriate care.
“Kern Family Health Care is committed to ensuring our members receive the care they need,” the statement said. “As a managed care plan, we utilize a prior authorization process that confirms benefits are approved based on medical necessity and utilized properly. We are a public entity and have a fiduciary responsibility to ensure appropriate use of taxpayer funds and that members receive the services they need. If a member is concerned, we strongly encourage them to contact our Member Services Department for help. We value our partnerships with providers by listening and working with them, so that our members receive high quality care.”
After multiple denials, Walker filed an independent medical review, and Elizah’s services were reinstated. However, Walker said many families remain without care.
“Kids with autism rely on these services not just right now, but for their future,” she said. “Without them, it’s an everyday struggle for families.”
Advocates are now calling on the Department of Health Care Services to investigate Kern Health Systems and Allmed Health, with the goal of halting ABA denials and restoring services.
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