Diagnosis Bottleneck in Michigan

Rosemary Parker reports at MLive:

The state of Michigan delayed enacting autism coverage for children covered by Medicaid until April 2013, a year after the bills were signed into law; then, citing a lack of money, they limited eligibility to children under the age of 5.

Meanwhile, the state's largest private insurer, Blue Cross-Blue Shield of Michigan, required that to be eligible for coverage of autism therapies children must be diagnosed not by their pediatrician or psychologist, but by Board-certified Behavior Analysts at approved Autism Evaluation Centers — of which, in 2012, there were only three in the state, Schrum said.

With approximately 18,000 children believed to be suffering from autism in Michigan, "within weeks, all (of the existing evaluation centers) had a waiting list of 12-18 months," Schrum said.
"Between Medicaid and Blue Cross, the systems have created a bottleneck that prevents children from accessing services," Schrum said.

That kind of roadblock nearly shuttered the $1.7-million Great Lakes Center.

"It almost killed us the first year," Schrum said. Even with cut-backs and staff layoffs, it took until December 2013 for the Center to stop losing money, he said.

The situation has slowly improved. In July 2014, 10 centers were listed on the Blue Cross website as authorized to diagnose children with autism. Eight of those are on the east side of the state, and two in Grand Rapids.

Their waiting list? Although a few centers can schedule an initial appointment within several weeks, for many, the wait is much, much longer. At the University of Michigan Health System, "we're scheduling 12-18 months out," a receptionist said.