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The Silent Crisis of Autism Services in Colorado

Updated: Mar 17



Colorado is facing a crisis for Autism services.  The average child is diagnosed with Autism in Colorado will have to wait more than 6 months before they can begin receiving services.  Early intervention is critical to effective services- losing 6 months of early intervention can dramatically effect a child’s outcome.  


Why are waitlists for Autism services in Colorado 6 months long?  The answer is that there are too few providers, and providers are either leaving the state or going bankrupt.  The billing rates that providers receive for providing services for Autism and other developmental delays are practically the same they were 5 years ago, while the cost of doing business has gone up nearly 30%.  This has made Autism services in Colorado an unsustainable business prospect for many, and they are fleeing.



Waitlists to get Autism Services in Colorado


Applied Behavior Analysis is generally accepted as the “gold standard” for services for ASD and other developmental disabilities. It is the most widely accepted therapy, and has the most evidence-based platform for effective results.  Autism services are critically time sensitive, and the effectiveness is at its highest the sooner a child can get services. If a child starts comprehensive therapy at 4 because they had to wait for services, it will impact their entire life.


Independent surveys conducted among companies that provide ABA services in Colorado in November of 2022 and again in June of 2023 found that on average new clients had to wait 6 months to enter their program.


The average family whose child receives an Autism diagnosis will have to wait half a year before a provider can begin services with them.  This is after they have waited to get the initial diagnosis, which can easily take 6 months to one year (Per Children’s Hospital).


The surveys also showed that these waitlists are getting longer, rather than shorter.  In the last 8 months, the waitlists have grown by 14%, or 5 children.  Please note, these data do not reflect the recent incidents in June, 2023 (see below).


 

November 2022

June 2023

Average Wait

6 months

6.8 months

Maximum Wait

12 months

30 months

Waitlisted Clients

23.4 

28.5

Table 1: Survey of Colorado ABA providers in November, 2022


(N = 23 providers) and June, 2023 (N = 17).


            Families seeking services for Autism are in a difficult position in Colorado, and it is getting worse.




Autism Service Providers Leaving Colorado


This crisis in Colorado getting dramatically worse.  Companies are leaving Colorado, going out of business, and cutting ABA services because they are unable to make a profit or break even. 


In the last few years, at least 8 companies providing ABA services to children and adults with Autism and Developmental Disabilities have either left the state of Colorado or have dramatically cut their ABA services because of difficulty breaking even.  These 8 companies comprise at least 18 centers serving children with Autism.  It is estimated that this will impact services to between 400 and 900 individuals with Autism and other Developmental Disabilities in Colorado. In addition to the above, other companies have significantly cut their ABA services offered to pivot in other directions that have better return.


If the above aren’t worrying enough, the cuts to services seem to be accelerating.  In the last few months:


  • Update: Since writing this blog, on July 12, 2023, Hopebridge Autism Therapy Centers has announced that they will be closing ABA services in all 8 of their Colorado centers.  Early estimates are that this will remove services for 250-300 clients.  

  • As reported in the news on June 21, 2023, Autism Support Services LLC will be leaving Colorado, and laying off 239 employees in the Autism services industry across three centers in Colorado.

  • Additionally, as reported widely on June 12, 2023, the Center for Autism and Related Disorders (CARD) has recently filed for bankruptcy. They have 9 centers in Colorado.

  • On March 24th, 2023, the Colorado Department of Health Care Policy and Financing (HCPF) had a public meeting to review Medicaid provider rates (More information available here).  During this meeting (recording available), several providers expressed concerns with their ability to continue to provide serves in Colorado.  One nation-wide ABA provider with 8 centers in Colorado stated that they have not been able to make a profit in Colorado and consequently they are engaged in internal discussions on whether to pull their services from the state entirely.


The effect of these latest events has not been felt yet on the waitlist numbers, but will be substantial.



Medicaid Rates for ABA Autism Services


Rates in Colorado for ABA Autism services have remained largely the same for the last 5 years.


Table 2: Percent increase in labor costs and Medicaid Reimbursement


between April 2018 and June 2023.


The cost of doing business for providers has gone up nearly 30% in the last 5 years, while the amount they are reimbursed by Medicaid has gone up only 7%.  This has driven providers to cut services, leave the state for other states with better profit margins, or go out of business.  Among the providers I know, many are worried they will not survive the year.



Other States 


Colorado is not the only state facing a critical shortage of ABA Autism therapy providers. According to Autism New Jersey, New Jersey faced a similar situation to ours, and responded by increasing their rate earlier this year from $44.80 to $60 per hour:


  1. Families were not able to get ABA services, and expressed a great deal of frustration (they had waitlists seemingly equivalent to Colorado).

  2. Upon looking into why ABA services weren't available, they discovered that the low RBT rate meant that providers were losing staff because they couldn't afford to pay them more.

  3. To solve the problem, they gave providers a 36% rate increase, which has been very favorably looked upon and has made a massive impact in the availability of services.

Louisiana is another example showing that if parties work together, compromises can save families from a dire situation.  In 2022 they raised their Medicaid rate for 97153 by 31.6%, making their state welcoming to service providers.



Key points:


Colorado is facing a silent crisis that very few people, outside of the Autism community, are aware of.  It is generally understood that Early diagnosis and services for Autism is a critical component to therapy. Colorado has 6 month long waitlists to receive ABA Autism services.  These 6 months are usually following waiting 6-12 months to receive the initial diagnosis.  Families are left waiting for at least 6-12 critical months before they can get the help they need.  These waitlists are only growing.  Providers that are eager to provide services in Colorado are leaving and cutting services, citing an inability to break even with the current Medicaid rates.  These rates have remained stable over the last 4 years, while the salaries that need to be paid to ABA therapists has grown over 26%.


It is difficult to adequately depict the difference that waiting 6 months for services has on a child’s outcome.  It effects their ability to learn in school, which impacts their ability to advance in school.  Eventually the cumulative result of those lost 6 months can mean massive differences in their ability to function and live independently.  The opportunity cost is only visible to the families and the providers that work with these individuals.  The opportunity cost not only effects the individual, but their family, their community, and the state as a whole.  Perhaps there is no way to calculate the eventual cost of the growing crisis in Colorado, but being aware of it is a great start.


HCPF has a committee that is currently considering whether to change provider rates.  If you are concerned about this issue, they are open to hearing from the public.  Their information and email can be found here.

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