Autism centers are leaving Colorado, landing kids on waitlists

BY JENNIFER BROWN THE COLORADO SUN

Colorado has lost at least nine agencies that provide therapy for children with autism in the past year and a half, leaving hundreds of families without care and lling up waitlists across the state. erapy providers say the reimbursement rates they receive from the Colorado Medicaid program are too low to keep their doors open, especially after many state residents became eligible for the federal-state insurance program during the pandemic.

At the same time, Colorado is facing a health worker shortage and autism therapy agencies say they are struggling to pay workers enough to keep them.

“ e impact has now reached a dire state,” said Ken Winn, president of Colorado Association for Behavioral Analysis, a nonpro t member organization. “Providers are leaving the state in droves.” e center had more than 40 clients who attended its daylong behavioral health program in Englewood that focused on helping nonverbal children learn to communicate and control aggressive behaviors. e small business lost $700,000 in 2021 and $250,000 in 2022, said CEO and founder Brian Lopez, a neurodevelopmental psychologist.

One of the latest to close Colorado operations is JumpStart Autism Center, which shut down in May.

About 70% of JumpStart’s clients were on Medicaid, while 30% had private insurance that reimbursed more for services. ose percentages ipped during the pandemic, when tens of thousands more Coloradans became eligible for Medicaid during the public health emergency. e center lost $5 per hour for every client on Medicaid, Lopez said. e state’s reimbursement rates have not kept up with the cost of operations, including salaries and its lease, he said.

“As a small-business owner, with my lease up in June 2023, I could not foresee taking out another ve-to-seven-year lease and putting $2 million-$3 million in when I knew the numbers weren’t going to work,” Lopez said. ”It felt like it was too much of a personal jeopardy to do it.”

Lopze started JumpStart in New

Mexico and opened a Colorado o ce in 2016. Medicaid reimbursement rates are high enough in New Mexico that the center is able to continue operations there, even with about 75% of its clients on the government insurance program, Lopez said.

New Mexico reimburses the center for training parents, while Colorado does not. Parent training is necessary, therapists said, so children who’ve learned how to communicate with their therapists can use the same methods at home. A child with autism who has a headache might repeatedly hit their head, for example. But with behavioral therapy, they might learn to point to a picture of someone in pain.

Colorado also limits therapists to about two hours to assess a child’s needs before setting up a behavioral therapy road map, though the industry standard is eight, therapists said. New Mexico’s Medicaid program allows eight hours, giving therapists time to gure out how to set up a comprehensive program. A child who is not using the toilet at age 7, for example, would see a urologist to make sure “we aren’t treating medical issues with behavioral interventions,” Lopez said.

A spate of recent closures also included Hopebridge, a national company that had several locations in Colorado, including in Denver, Fort Collins, Greeley and Colorado Springs. Another national company, Kadiant, left last year.

Colorado Medicaid used to fund services for children with autism through a “waiver” program, a comprehensive set of services for speci c groups of people who must qualify and often wait for a spot in the capped program. Colorado has various waiver programs for children and adults with intellectual and developmental disabilities, for example, including some with 24/7 in-home services. e committee will submit its recommendations to the legislature’s Joint Budget Committee in the fall. Any approved changes would not take e ect until next July. e number of Colorado children receiving those bene ts climbed 200%, to 5,600 children last year from 2,437 children ve years ago. e annual cost per child rose to $3,400 from $1,900. And the total program cost is up 400%, now $126 million compared with $28 million ve years ago.

But the autism waiver program was capped at just 75 people.

In 2017, the federal government ordered Colorado to end the waiver program and instead add bene ts for children with autism to its Medicaid program. e state created a handful of billing codes that allowed providers to get reimbursed for pediatric behavioral health therapy for children with autism. ose rates have not been updated since then, although the legislature has approved across-the-board rate increases for Medicaid providers, including 3% this year.

And the pediatric behavioral therapy rates are under review now.

A state group called the Medicaid Provider Rate Review Advisory Committee, which makes rate change recommendations to the legislature, decided in late July to recommend an increase that would bring Colorado rates in line with 10 comparison states. e group also plans to recommend that the Medicaid division begin covering additional bene ts, such as parent training.

A 2022 state law required the committee to review rate changes for each type of provider category every three years instead of the previous requirement of every ve years. e change was part of a greater e ort to adapt more quickly to in ation and workforce shortages, Medicaid o cials said.

In the past ve years, the number of children qualifying for Medicaid’s pediatric behavioral health bene t has jumped dramatically — and so has the cost.

According to the Medicaid division’s analysis, which con icts with autism therapy providers’ data, Colorado’s reimbursement rates are 93% of what other states are paying. Providers accused the department