The state Senate approved an overhaul of Blue Cross Blue Shield-MI’s corporate structure in efforts to modernize the company and level the playing field between the non-profit and its competitors. Read the full story here.
The costs topped $4,000 a month; Erin and Larry Nieman couldn’t afford it.
So the Southgate couple drained their savings to pay for therapy for their little boy, Noah, who has autism.
They downsized cars, skipped eating out, clipped coupons, gave up new clothes and a home phone. They held fund-raisers — bowling parties and spaghetti dinners. Credit card bills grew.
“It has been a very scary time for us,” said Erin, 34, a manager for the Michigan Department of Human Services. “We’re used to being financially secure. The scarier part for us would be if we could no longer get him the help he needed.”
Larry Nieman, 32, works in an information technology office for a social services agency. His wife’s father came out of retirement to help with the bills.
“It’s literally taking three incomes to make this work,” Erin Nieman said.
But for the Niemans — and thousands of other Michigan families coping with autism — life is about to get a lot easier.
Starting in October, a new law will force Michigan insurers to cover therapy for children with autism.
“The signing of this legislation changes everything,” said Judith Ursitti, liaison to state governments for New York-based advocacy group Autism Speaks.
From her office in New York, Ursitti has watched for four years as states passed laws that mandated insurance coverage for autism therapy. Before Michigan’s law — the 30th in the nation — was signed in March, the state was among the least friendly toward children with autism, she said.
The lack of insurance coverage for therapy — which can top $100 an hour — meant most families were cut off from services, relying on cash-strapped school systems and staff who often are poorly trained in working with autistic children, said Ursitti, who has a son with autism.
Additionally, it drove newly trained therapists to states with better insurance coverage for autism, leaving few therapists even for the families in Michigan who could afford their services.
“It was a no man’s land when it came to autism” services,” Ursitti said.
But Michigan’s new law is one of the “most robust” in the country, she said.
Not only does it require insurers to cover therapies, the law uniquely sets up an Autism Coverage Fund to reimburse insurers for services — $15 million for the first year. That means insurers can be reimbursed up to $50,000 for therapies for children through age 6; $40,000 for children ages 7 to 12 years old, and $30,000 for children 13 through 18.
So now Michigan is scrambling to prepare for this new demand on services, said Colleen Allen, president and CEO of the Autism Alliance of Michigan, which recently held a state conference for therapists, state officials, advocates and others.
More than 300 attended, in part to learn how to begin tapping into the complex world of insurance forms and provider ID numbers. Insurers, meanwhile, are stepping into new territory as well as they cover a whole new area of member services that include Applied Behavioral Analysis (ABA) therapy, an intensive therapy that relies repeated positive reinforcement techniques to teach skills and cement good behavior.
While social reinforcement — “great job!” — can motivate and encourage most children, children with autism seem disconnected from such social cues. ABA therapists may offer other rewards, such as M&M’s or time with a toy — along with verbal encouragement — to reinforce skills and good behavior. Eventually, the child associates verbal encouragement as a reward, no longer relying on candy or time with a toy, said Emily Besecker, a board-certified behavior analyst.
Besecker, 28, is from Bloomfield Hills. She moved back to Michigan last year in anticipation of the law change.
In Noah’s case, 30 hours of ABA therapy was tedious, but provided results that his mother characterized as nothing short of miraculous. Two years ago, it was as if Noah operated in his own world — not noticing activity or people around him. At 3 1/2 years old, his vocabulary was no more than 20 words. He wasn’t potty trained. He made no eye contact, and Nieman longed for a hug or a kiss from her little boy — the kind of affection so typical of young children.
Today, Noah’s vocabulary has expanded to more than 200 words. He is potty-trained and sings little songs. He knows colors. And he offers up those hugs and kisses, Erin Nieman said.
“He does the things that other people take for granted. … Excuse the language, but come hell or high water, Noah was going to have ABA” therapy, she said.
The benefits of therapy are clear, said Allen, at the Autism Alliance. And so is this: Michigan is in need of more therapists and fast.
Board-certified behavior analysts — those who can provide ABA therapy — command more than $100 an hour, but they can supervise the services provided by therapists who are not board-certified, reducing the overall costs.
Still, that means a lot of hiring and training in the next few months.
“I’m being realistic,” Allen said. “It will take a while for services to meet demand, and there will be frustration. But I’m confident that we’ll get everything online so much faster than other states. You can literally set up shop as a qualified provider (in Michigan) and as soon as October rolls around, you’ll have people lining up at the door.”
Jordan Boudreau’s phone is already ringing.
A former Milford resident, Boudreau, 29, left Michigan after graduating from Western Michigan University in 2006 with a psychology degree. Though he and his wife, Christina, 24, wanted to raise their children in Michigan, both knew that it would be difficult for Boudreau, a board-certified behavior analyst, to find enough clients for his services, which can cost $150 an hour.
So Boudreau moved to Flor-
ida, which began requiring coverage for autism therapy in 2008, where the change made a huge difference in quality of life for families with autistic kids.
“Families were able to get services. Families were able to go out and do things with their kids and become more part of the community, of society,” he said.
Boudreau moved back to Oakland County in December, just as lawmakers inched closer to enacting similar laws here. Now, he said, he’s offering services — $200 for four sessions through his website www.inthebesthands.com. It’s barely a break-even point for now.
But he’s hoping that it will build his client rolls by this fall, when insurance coverage kicks in.
More established services are gearing up, too. The Judson Center, which offers ABA therapy for children, among other services, hired Besecker last year in anticipation of the law change. Additionally, a Judson counselor is getting her board certification to offer ABA therapy, and Judson will add more therapists in the coming months, said Marn Myers, Judson president and CEO.
“We took a leap of faith,” Myers said. “With services so expensive, few families could afford (therapy). But we’re capacity building now.”
For a lot of those families, said Myers at the Judson Center, “there is hope again.”
More Details: New definition
A greater understanding of disorders on the autism spectrum is ever-evolving. The American Psychiatric Association is reviewing the diagnosing criteria for autism — essentially outlining for clinicians what will and will not be considered autism. In March, the U.S. Centers for Disease Control and Prevention revised its estimates for how many children have autism — increasing rates from 1 in every 110 children to 1 in 88.
New program offers affordable coverage for individuals, rural communities, small businesses
The Centers for Medicare and Medicaid Services (CMS) today announced its award of $72 million in financing for the new Michigan Consumers Healthcare CO-OP (MCHCO), a member-governed nonprofit health insurance company that will help to control costs while providing accessible healthcare for all residents.
“We’ve been given the opportunity to be pioneers in a new business,” said Bruce Miller, president of the MCHCO Board. “It is an opportunity and an obligation we take very seriously. All of us who have worked to bring a Consumer Oriented and Operated Plan to Michigan will do our very best to make the insurance plan work to the benefit of Michigan residents.”
The goal of health insurance cooperatives such as MCHCO is to make sure consumers have affordable choices when Michigan residents start shopping for government-subsidized health insurance from state insurance exchanges that are set to begin operating in 2014.
The development of MCHCO is part of the federal Affordable Care Act (ACA), which creates a new type of nonprofit health insurer, called a Consumer Operated and Oriented Plan (CO-OP). CO-OPs have member-based boards and are meant to offer member-friendly, affordable health insurance options to individuals and small businesses. Using low-interest and no-interest loans from the U.S. Department of Health and Human Services (HHS), the plan is to ensure that every state will have at least one healthcare CO-OP chartered specifically to make sure insurance is affordable for everyone:
- CO-OPs will be open to all comers, including independent workers typically shut out of the traditional healthcare market.
- Americans making less than 400 percent of the Federal Poverty Level (FPL) will be eligible to receive financial support from the government to pay for their CO-OP health plan.
- The CO-OP will enter the market and compete with private insurers and offer insurance through a state-level marketplace called the Exchange. The state Exchange will be designed to make it easier for consumers to shop for and understand insurance plans.
By Jan. 1, 2014, Michigan residents will have the opportunity to buy health insurance coverage as individuals or families from the Michigan Consumer Healthcare CO-OP. The MCHCO will differ from other insurance companies because it will be governed by its members – the individuals and businesses that purchase the coverage.
“MCHCO will level the playing field for individuals and groups that are often not well served in the current health insurance market,” said Miller, who currently serves as executive director of the nonprofit Northern Health Plan and TENCON Health Plan, which provide basic medically necessary services at little or no cost to more than 10,000 low-income residents in 18 Michigan counties who have no other access to healthcare coverage.
MCHCO was organized by a coalition of 15 Michigan nonprofit corporations that are known as County Health Plans (CHPs). CHPs currently operate in 74 of Michigan’s 83 counties and provide noninsurance coverage to 150,000 Michigan residents. MCHCO hopes to use the existing delivery system to develop a statewide network including the nine counties that are not currently served by a CHP.
The insurance offered by MCHCO will be targeted to people with incomes between about 139 percent and 250 percent of the Federal Poverty Level (roughly $26,000 to $40,000 annual household income depending on family size) – but anyone can buy insurance from MCHCO.
Based on actuarial analysis of the market, MCHCO projects an initial enrollment of about 37,000 members.
“The Consumer Oriented and Operated Plan will use any profits to increase benefits and reduce the price of insurance,” Miller said.
The $72 million CMS loan will be used to develop the subscriber-run plan and support the plan’s reserve requirements. “The entire loan amount must be repaid to the federal government no later than 2033,” Miller said. “Our plan is to repay the loan sooner.”
MCHCO is preparing to apply for a health insurance license from the Michigan Office of Financial and Insurance Regulation (OFIR) in order to begin enrolling customers in October 2013 for insurance scheduled to take effect Jan. 1, 2014.
To date, 11 other organizations have received loans through the CO-OP program. Those organizations are in Iowa, Montana, Nebraska, Nevada, New Jersey, New Mexico, Oregon (two), New York, South Carolina and Wisconsin.
For more information about the Michigan Consumers Healthcare CO-OP, visit www.mchco.org.
SOURCE Michigan Consumers Healthcare CO-OP
If you were on spring break last year in FL you probably heard tons of stories on the news about families who were forced to abandon their homes because they were built with “Chinese drywall.” This literally was a health issue. Now Chinese drywall companies appear to be fighting compensating U.S. homeowner’s effected by their product. This has been a big insurance case in the past year or so as homeowner’s are looking to anyone they can for damages. Luckily Michigan homeowner’s are unlikely to be effected by this problem. The drywall was purchased as a last resort during the time of homes being rebuilt following hurricanes in or about 2005 in the southeast. Demand was so high that even new home builders will getting drywall anywhere they could and China was a market eager to fill the orders. So imagine moving into your dream house only to find out five years later that it was actually making you and your family sick.
Here is a very simple worksheet I ask my life insurance clients to work on to determine how much coverage they need. Remember needs change over time, so it’s a great idea to review this worksheet at least every five years. The link below will take you to the worksheet.
Whether it’s with the Reno Agency or your financial services professional, resolve to review your financial plan in 2011.
If you are ever sued, your standard homeowners or auto policy will provide you with some liability coverage, paying for judgements against you and your attorney’s fees, up to a limit set in the policy. However, in our litigious society, you may want to have an extra layer of liability protection. That’s what a personal umbrella liability policy provides.
An umbrella policy kicks in when you reach the limit on the underlying liability coverage in a homeowners, renters, condo or auto policy. It will also cover you for things such as libel and slander.
For about $150 to $300 per year you can buy a $1 million personal umbrella liability policy. The next million will cost about $75, and $50 for every million after that.
Because the personal umbrella policy goes into effect after the underlying coverage is exhausted, there are certain limits that usually must be met in order to purchase this coverage. Most insurers will want you to have about $250,000 of liability insurance on your auto policy and $300,000 of liability insurance on your homeowners policy before selling you an umbrella liability policy for $1 million of additional coverage.