I want to start this week by thanking our military veterans for their service to our country. I hope everyone takes a moment on Veterans Day, on the eleventh hour of the eleventh day of the eleventh month, to reflect on the sacrifices made by the men and women in our military and their families. Particularly in a time when our nation feels very divided, our service members work to protect ideals and freedoms that are bigger than any one person and span back further than any elected official’s term. Thank you for your service and sacrifice.

I also have another set of families on my mind this week. It has come to my attention in recent weeks that United Healthcare/Optum has distributed notices to many of the state’s Applied Behavioral Analyst Therapy (ABA) providers that they intend to cut Medicaid reimbursement rates by 50% or more. ABA providers deliver therapy services to autistic children in our communities. Optum contracts with the State of Nebraska to deliver approximately 1/3 of services to low-income children and youth in the state.

I am concerned about the affects these cuts will have on our communities, particularly in rural areas. Access to services – including healthcare services – is a major factor in recruiting families to come to and stay in rural Nebraska. Although providing these services sometimes comes at a cost to the taxpayer, inability to access services come at its own expense.

For children with autism, early intervention is critical. ABA therapy programs can help increase language and communication skills; improve attention, focus, social skills, memory, and academics; and decrease problem behaviors. Therapies are most effective when delivered in-person and a robust provider network cannot be replaced purely by telehealth. It is vital that we keep quality providers in Nebraska.

Without early access to therapy services provided by ABA practitioners, many children with autism cannot be successful in school and the best they can be in their adult lives. Over many years, the Legislature has chosen to invest in these life-altering services, a critical decision which will reduce the need for a long-term financial commitment in public assistance and healthcare services. It also reduces strain and expense in our school systems, which already struggle to hire and keep paraeducators and special needs teachers.

Notices about these drastic cuts have been sent to some of the state’s largest providers. Many are concerned about their ability to keep operating in Nebraska. Optum cites a rising number of claims and higher-than-average reimbursement rates as justification for the cut. To me, the increasing claims show the need for ABA services across the state. Optum is required in its contract with the State of Nebraska to maintain an adequate network of providers. I am worried that if Nebraska takes the significant step back in rates that Optum is proposing that we will begin losing therapists and providers to other states.

I understand that there has to be a balance between insurance providers and healthcare providers. I also think it’s important that the State be strategic in how it invests taxpayer dollars. Low-income children and youth with autism are not big corporations and health systems going to battle. These are some of the most vulnerable in our communities and an early investment in their care can set them up to be good students and productive citizens in the future.

It is for these reasons I have agreed to sign-on to a letter to United Healthcare that is currently circulating asking United/Optum to “show their work” on how they justify cutting Medicaid reimbursement rates for ABA services in half without affecting network adequacy. I am not convinced that these cuts won’t hurt our children and families.

It is a privilege to represent you in the Nebraska Legislature, and I look forward to hearing from you regarding issues that are important to you. I can be reached at 402-471-2729 or by emailing me at mjacobson@leg.ne.gov.