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 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.

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

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.

“As a small-business owner, with my lease up in June 2023, I could not foresee taking out another veto-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 ofce 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 com - pany, Kadiant, left last year. ose rates have not been updated since then, although the legislature has approved across-theboard rate increases for Medicaid providers, including 3% this year. 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.

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.

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.

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. 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.

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 of cherry-picking states for comparison purposes that made Colorado look better.

Medicaid o cials said autism therapists, along with many other medical and mental health providers, are struggling now because of a huge swing in the wage market.

“Health care workers have really been through a tough time over the last several years and we’ve had individuals leave the workforce,”

Kim Bimestefer, executive director of the Colorado Department of Health Care Policy and Financing, which includes the Medicaid division, told e Sun. “ e wage rates for health care workers have gone up in an unprecedented way and that’s sometimes putting pressure on organizations who are passionately trying to provide care to their customers, their patients.”

Bimestefer pointed toward $26 million in recent investments by the legislature and Gov. Jared Polis

SEE AUTISM, P16

FROM western end of the DISH campus, spanning the Littles Creek Trail. It will be on supports that keep the booster about 10 feet o the ground.

Councilors Patrick Driscoll, Kelly Milliman, Stephen Barr and Jerry Valdes raised concerns regarding the location, particularly the impact it would have on foot and bike trafc on the Mary Carter Greenway.

Ergen said that DISH landed on the location because it was “o the beaten path,” referring to Bowles and Santa Fe tra c, while still being accessible to locals.

Reester and Ergen assured coun- cilors that the placement of the rocket will not signi cantly hinder foot tra c, as there will be a plot of concrete set aside from the path where people can stand and view. Despite concerns, the plan received general support from councilors.

Milliman said that, aside from the economic and tourism bene ts, the educational advantages will serve the community well.

“To get these kids interested in engineering, I am truly so excited about all of this,” Milliman said during the discussion period following the presentation.

Reester also sees the exhibition as an opportunity to boost use of public transportation, as it may be di cult to nd parking near the DISH campus.