Fighting for access:
Ava Pollard is no stranger to the Georgia State Capitol. For seven years, Ava and her mother Anna appeared to testify before legislative committees and lobby in the halls. It is the namesake of the AVA law passed in 2015, which requires insurance to provide coverage for children for autism-related treatments.
“It’s weird being here when it’s empty,” said Ava, walking the halls again. Six years have passed. She is no longer a little girl. She is a senior student preparing to head off to college. Her mother stands beside her, beaming with pride.
Her mother remembers when Ava was diagnosed as a young child with autism.
“She was nonverbal, she had no skills when she was 2.5 years old. No feeding skills, no playing skills. The shocking part was none of the services the doctor prescribed were covered by insurance or Medicaid,” her mother said.
But Ava’s parents knew that intervening at a young age could make a difference. So they maxed out their credit cards. Their families are also torn apart. After a few weeks of ABA, progress was clear. Ava spoke her first word.
“I think it was Chito. We have to find the things she likes,” said her therapist. Anna recalls. For the record, Ava still loves Cheetos.
Her family could have moved to a state where ABA treatments are covered by insurance, but Anna said she wasn’t feeling well.
“How can I leave this state that I love, my family has been here forever. And how can I leave knowing that all these children will not be served? Then I decided that we should stay, we will get Ava’s treatment and we will treat everyone else because this is wrong,” she said.
Lindsey Jones, an ABA-trained psychotherapist, is not surprised by Ava’s story. She says the therapy method is an important tool for helping children and their parents find healthy ways to communicate before frustration turns into aggression.
“We’re basically figuring out the job. Jones, who works with youth at Creative Community Services, explained why this person is doing the behavior they’re doing.” Sometimes young people grow up too big and their aggression becomes dangerous. I think this is the time when parents feel overwhelmed and can’t handle it.”
But children with ADHD and PTSD, the initial diagnosis of abandoned children, generally do not qualify for coverage. The AVA Act only pertains to children with autism.
“ABA can help anyone,” Jones said, acknowledging that the risk of abandoning some of these children is real. She says that if treatments like ABA can be used early on with children, and not just those with autism, some families will likely stay together.
“This is the precautionary aspect, I hope one day we can stand on that side of the fence and offer help before a parent makes that decision,” she said.
Insurance coverage is not enough:
Even if Georgia expands its services, giving someone access is not enough. There should be therapists to provide the service. That’s why when the AVA law was passed, Georgia set a higher Medicaid reimbursement rate than other states.
“It brought a lot of providers here to Georgia,” said Anna Pollard.
It is proof that if you fund a program correctly, then providers who are able to deliver it will come. Child care advocates say it’s time to take the same approach in other parts of our behavioral health care system. And we can’t wait seven years to do that.
“If we don’t address the issue of equivalence, we will continue to struggle,” said Gwen Skinner, vice president of operations at Devereux, a residential psychotherapy facility in Metro Atlanta.
“Devereux serves children with significant emotional distress,” Skinner said.
It is one of the few facilities in Georgia that will work with children with aggressive behaviors, which is another gap in our behavioral health care system. Skinner knows about the vulnerabilities firsthand, as well as through her work as chair of the Georgia Workforce and System Development Committee on the Behavioral Health Reform and Innovation Committee, BHRIC.
“It’s not about the challenge working with the population, but you can recruit and retain professionals to be able to do it,” Skinner explained. “It’s a specialized service so you have to accept that providing a specialized course of treatment will cost more.”
It may be more expensive, but she says the state is not paying more to force Devereux and others to take patients from states that are reimbursing the costs at higher rates. For example, she says, Georgia pays about $2,850 for young adults to receive treatment for a week at Devereux. Florida will pay $4,200.
We are losing capacity in Georgia. Service providers are starting to take more and more young people out of the state in order to survive financially. And that means that when Georgia guys have those needs, there’s nowhere to go,” Skinner said.
Gaps in access lead to gaps in the workforce. Take child psychologists, for example. It’s a specialized field, so it requires more years of training than a pediatrician. This means more debt. However, a 2019 Milliman Research Report found that insurance in Georgia pays 38 percent less for behavioral health care than Medicare.
“It is expensive to become a psychiatrist. But if you choose it professionally, you know you will make less than if you choose the role of a traditional medical doctor. So we know there has to be parity in what professionals make,” Skinner explained.
The sobering effect of this wage disparity, according to a VOICES survey of Georgia children, is a shortage of mental health professionals in 150 of our 159 counties. Seventy-six of those counties have no full-time psychiatrist or psychiatrist. Access is further eroded when, according to research by BHRIC, only 53 percent of psychiatrists in Georgia accept Medicaid.
The problems with our workforce extend far beyond jobs that require advanced college degrees. Many families say what they need is simply support at home, and trained staff who can help with routine care. Getting a permit for this is tricky, and getting people to do the job can be even more difficult since they often only pay ten dollars an hour.
“We know you can’t live on ten dollars an hour. This is really, really hard work,” said Eric Jacobson, executive director of the Georgia Council on Developmental Disabilities. “When we’re talking about increasing nursing home rates or hospitals getting increased rates from the state. It never included providers of developmental disabilities or other home and community services in that conversation.”
Since most children who qualify for these services are on Medicaid, reimbursement rates for these types of services will also be determined by the Department of Community Health and the legislature.
That’s why Skinner took the opportunity to work at BHRIC.
“My first thought was, ‘I want to be a part of that.’ My second thought was, ‘I hope it’s not just another committee that makes recommendations and doesn’t lead to sustainable change for our state.'” Skinner remembers, because that’s where we have to go.
When asked if this sustainable change has yet occurred, she quickly replied, “No.”
But Skinner believes the 2022 legislative session will bring about change. She says Georgia needs a state welfare plan that provides a roadmap for care, regardless of who is the governor or leads the departments involved.
Change is possible:
Anna and Ava warn families not to be prepared to fight over money.
“I’ll never forget a legislator… He looked at me and said, It’s not personal. And I thought it was very personal! Anna Pollard remembers it.”
According to the Georgia Insurance Commission, the AVA law increased monthly premiums by 97 cents. But Ava says look what this dollar did to her.
“I wouldn’t be where I am today at all,” Ava said.
From a young kid who can’t talk to a senior at Tombstone High School. Ava is a cheerleader at the top of her class as a double registered student in South Georgia.
“The answer can’t be how to do it, we keep throwing money and getting more providers. The answer has to be how do we focus on ensuring that what this kid gets is what the science says he should get. What results? What should they expect?” Anna said. She believes that if we follow this science, we’ll see service loopholes and places where providers and insurers aren’t held accountable.
This is now the focus of Anna Pollard’s new battle. I held a job at the Center of Excellence for Behavioral Health, lobbying across the country this time around to make sure existing programs use proven methods to get good results.
The Pollards hope their story offers some hope that change can happen — if you’re willing to fight back.
During this investigative series, we ask those in the middle of it, ‘What’s the solution’. That’s what they say.
- Increase reimbursement rates for therapists who work non-traditional hours, with children with aggressive behaviors, or with children in rural areas.
- Increase the reimbursement rate for home support and provide greater access when medically necessary.
- Expand coverage and access to ABA treatments for children who could benefit, not just those diagnosed with autism.
- Create a loan repayment program for behavioral health clinicians who agree to work in underserved communities.
- Determining the equivalence of reimbursement for mental health 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 the inequality, injustice, and inefficiency that people in power have created across Georgia and across the country.