Starting Monday, Utah families who have young children with autism can apply for free treatment provided by a new pilot project but if too many seek help, they'll need luck to win a slot.
About 250 kids can be served through the Medicaid-funded portion of the project, which is open to children who are not covered by the low-income public health insurance plan. If more children apply than can be helped, which is likely, applications will be ranked at random, similar to a lottery, explained Utah Department of Health spokesman Tom Hudachko.
"We'll assign a certain number of openings to different geographic areas based on population. We want to make sure rural regions get their fair share," Hudachko explained. "So if the Salt Lake Valley Health Department serves 37 percent of the population, they'll receive 37 percent of the slots."
The state was notified Wednesday that federal health officials had approved using Medicaid funds for the two-year treatment pilot.
"This is so exciting," said Rep. Ronda Menlove, R-Garland, who carried the bill in the last legislative session to create the program, including an autism treatment fund to accept private donations. "The federal government recognized that we are doing something innovative."
Applicants need not be on Medicaid. Any child between the ages of 2 and 6 who meets certain requirements is eligible. The child needs to have been clinically diagnosed with an autism spectrum disorder and be a U.S. citizen and Utah resident born between April 1, 2007, and October 31, 2010.
In addition, the child must not have assets, such as a bank account or trust fund, in his or her name in excess of $2,000. Applications, due by Oct. 31, will be available Monday at health.utah.gov/autismwaiver.
Families will not be required to make co-payments or pay any co-insurance charges.
During the 2012 Utah Legislature, some parents had pushed for a mandate to force insurers to cover treatment for autism. Menlove's pilot was pitched as an alternative, and was supported by insurers and some parents.
Three groups of children will be served: the 250 children chosen for the Medicaid portion, supported by $4.5 million in Medicaid dollars; up to 50 covered by the Public Employees' Benefit and Insurance Program; and up to 100 from the autism treatment fund, paid in part with private dollars. Those children may be on private insurance or be uninsured.
Menlove has said she expects donations, including those from insurers, to reach $1 million.
But so far, the government Medicaid and the state, which contributed $1 million are the sole supporters. The state has yet to receive any donations. Intermountain Healthcare said in August that it plans to contribute $500,000.
Menlove said Thursday that large Utah health insurers have assured her they will make donations as soon as next week. She wouldn't say how much has been pledged until the money arrives.
But she hopes the Medicaid waiver will fuel more private-sector involvement.
"During the legislative session there was some debate about what treatment will really cost," she said. "So with Medicaid we can test it and produce hard data to move the discussion forward, instead of relying on actuarial studies based on projections."
A recent study of a small area along the Wasatch Front found that 1 in 47 children in Utah may have autism the highest rate in the nation compared to 1 in 88 children across the country. In Utah, the rate is 1 in 32 boys versus 1 in 85 girls.
Tribune editor Sheila R. McCann contributed to this report.
How to apply
Children between the ages of 2 and 6 who meets certain requirements can apply for autism treatment through the Medicaid-funded portion of a state pilot project.
Applicants need not be on Medicaid. To be eligible, kids must:
Be clinically diagnosed with an autism spectrum disorder.
Be a U.S. citizen and Utah resident.
Have been born between April 1, 2007 and October 31, 2010.
Not have assets, such as a bank account or trust fund, in his or her name in excess of $2,000.
Applications will be available Monday at http://www.health.utah.gov/autismwaiver.