HONOLULU (HawaiiNewsNow) - Suzanne Egan is the single-mother of a severely autistic five-year old boy. The Kalama Valley resident says she can no longer afford the $5,000-a-month treatments for her son's autism, which she believes should be covered by Medicaid.
"My child has not received the interventions he requires in his formative years and that's going to affect him for the rest of his life," said Egan.
On Friday, Egan and the Hawaii Disability Rights Center filed a class-action lawsuit in U.S. District Court in Honolulu, accusing the state Department of Human Services of ignoring federal Medicaid rules require the state treatments for the autistic.
The service is called applied behavioral analysis treatment, or ABA, and it involves one-on-one counseling and behavior modification training.
Many say it's effective in treating autism in early childhood development. But it costs between $30,000 and $50,000 per student, which can translate into millions of dollars for a school system. And that's why the state is balking.
Louis Erteschik, executive director of the Hawaii Disability Rights Center, said the federal Medicaid program's Centers for Medicare and Medicaid Services recently concluded that coverage for ABA treatment is mandatory for state Medicaid programs.
He said that 37 states in the country legally require private insurers to pay for these treatments and that many of the states whose Medicaid program don't pay for the services have been ordered to do so by the courts.
"Everybody is saying you have to cover it and DHS is not covering it. That's what it comes down to and this case is being brought to force them to cover it," Erteschik said.
According to Erteschik, the state believes the program will cost $20 million. But he pegs the start-up costs at $3 million.
That's far less than the tens of millions of dollars that the state could wind up paying for the lifetime treatment for severely autistic children, he said.
Hawaii Disability Rights Center and Egan, who are represented by local attorney Paul Alston and his firm Alston Hunt Floyd & Ing, are seeking an injunction that would require the state to provide the coverage.
We reached out to DHS officials but they had no comment.