TAMPA, Fla. — 1000’s of youngsters with autism and different disabilities in Florida are dropping medically-prescribed remedy after an audit revealed that unqualified therapists had been being paid by means of Medicaid.
On Dec. 31, Sunshine Well being, the corporate contracted by Florida to run a kids’s Medicaid program, will terminate its contract with MTM Well being, the corporate it employed to recruit and handle a community of remedy suppliers throughout Florida.
The community included music and artwork therapists and facilities the place kids can work together with horses and pets. Identified collectively as expressive therapies, quite a few research have proven they profit kids with autism, cerebral palsy, Down syndrome and different developmental and emotional points.
Commercial – Proceed Studying Under
Sunshine officers mentioned they ended the corporate’s contract with MTM after studying that some therapists it was paying didn’t meet Medicaid requirements, together with holding a Medicaid ID, passing Degree 2 background checks and possessing correct area certifications.
The upheaval has thrown Florida’s Medicaid remedy community into chaos, leaving most kids with out remedy classes till subsequent yr as suppliers are now not being paid. MTM additionally owes tens of hundreds of {dollars} to some practices, a number of suppliers informed the Tampa Bay Instances.
The lack of income has pressured some remedy practices to furlough staff.
“Some therapists have misplaced their total workload,” mentioned Elise Scullin, program director at Music Remedy St. Pete, which serves about 100 kids on Medicaid. “There may be plenty of uncertainty in regards to the future if there is no such thing as a resolution with Sunshine.”
Some practices are nonetheless offering remedy professional bono and are encouraging mother and father to hunt different funding sources comparable to state training scholarships.
Florida Music Remedy, which has studios in Melbourne and Fort Myers, served nearly 300 kids on Medicaid and is owed about $160,000 mentioned CEO Courtney Arndt.
Its 21 staff have taken a pay lower and the observe is utilizing cash it saved for a down fee on a brand new studio to pay salaries and proceed remedy classes at no cost.
“We’re operating on fumes and type messages from mother and father and a GoFundMe,” Arndt mentioned. “We’re seeing how far can that down fee can stretch.”
Sunshine Well being officers mentioned they plan to contract straight with suppliers and are serving to them register as Medicaid suppliers and to satisfy different requirements.
“If a member’s present supplier doesn’t meet Medicaid necessities, our Care Administration group is right here to assist members and their households transition easily to a brand new remedy supplier,” the corporate mentioned in an announcement offered to the Instances.
However the brand new contracts is not going to begin till Jan. 1, which means some kids may have missed nearly three months of remedy.
Lakeland mother Kristie Owens’ three sons ages 11, 13 and 16 have autism spectrum dysfunction and had been prescribed music remedy classes for the previous two years.
The oldest has extreme communication anxiousness however has improved by means of singing workouts along with his therapist. Her second son wouldn’t sit nonetheless when being learn to and was nonverbal. His therapist started singing the phrases in books to him and he now tells his nurses about his favourite animals.
However their in-home remedy classes halted about three weeks in the past after MTM stopped approving funds. For kids with autism who thrive on routine, it’s been a worrying time, Owens mentioned.
“She is a protected individual; when certainly one of your protected individuals stops exhibiting up, it’s an issue,” Owens mentioned. “My one son who’s nonverbal retains asking for his music.”
Music therapists are sometimes board licensed, which includes incomes a level in music remedy from an accredited increased training program and finishing a 1,400-hour internship underneath a professional therapist.
However music therapists who spoke to the Instances mentioned MTM had recruited and submitted Medicaid claims on behalf of practices that employed individuals with levels in music as therapists.
State regulation makes it a felony to observe well being with out a license, however “music therapist” just isn’t a licensed occupation in Florida. It’s, although, in 14 different states together with California, Georgia, Illinois, North Carolina, North Dakota, Ohio, and Washington.
Different well being associated professions, together with bodily and occupational therapist, acupuncturist and midwife, are licensed and controlled by the Florida Division of Well being. A 2017 invoice to license music therapists failed.
Primarily based in Missouri, MTM Well being was contracted by Sunshine Well being in 2021. The corporate took eight days to answer questions from the Instances however declined to reply why it contracted with uncertified therapists.
“MTM is dedicated to complying with all State and Federal necessities, which incorporates suppliers having a Medicaid ID,” mentioned spokesperson Michele Lucas in an e mail. “MTM is working diligently to make sure that Expressive Remedy suppliers are paid for providers which were offered.”
The Florida Company for Well being Care Administration is in command of the state’s Medicaid packages, together with Kids’s Medical Companies, the one run by Sunshine Well being.
Officers there declined to reply questions on what number of kids with disabilities have been affected by the termination of MTM’s contract and whether or not the company was conscious that uncertified therapists had been paid by means of Medicaid.
Spokesperson Mallory McManus mentioned that expressive remedy continues to be accessible for youngsters insured by means of Sunshine Well being however declined to elaborate. It’s the duty of plan suppliers like Sunshine Well being to make sure that in-network remedy suppliers are enrolled in Florida Medicaid to be reimbursed for providers, she mentioned.
“The Company is working carefully with Sunshine Well being Plan to make sure there are not any gaps in care and to make sure remediation of any disputes with suppliers of this service,” McManus mentioned in an e mail.
Permitting unqualified individuals to conduct music remedy classes might be damaging to kids, mentioned Jillian Mehler, a Central Florida music therapist.
Therapists conduct an in depth evaluation of youngsters’s wants and develop a therapy plan. The remedy is fine-tuned to work on motor abilities, communication and different talents.
Kids with autism might have acute sensitivity to noise, she mentioned.
“I’m skilled to see the cues {that a} youngster might exhibit to point out misery if music is just too loud,” she mentioned. “When you will have somebody that doesn’t have that coaching, positive music is enjoyable, nevertheless it’s not therapeutic.”
Her observe needed to cease remedy classes for nearly 40 kids on Medicaid. It offered free “closure” classes to assist kids modify.
Suppliers of different forms of remedy have additionally stopped receiving funds from MTM.
Tammy Sliger, the proprietor and director of Kiddy Up Ranch, an equine remedy heart in Hudson, mentioned MTM has not paid for classes courting again to Aug. 30, and she or he is owed at the very least $30,000.
The middle was serving 60 kids by means of Medicaid.
“Youngsters do that each single (week) for years — now you’re simply going to tear it out from them?” she mentioned. “Youngsters are distraught.”
Equine remedy is extra than simply using a horse. Kids are anticipated to discover ways to groom and tack, the time period for becoming a saddle and bridle. The classes are tailor-made to develop cognitive abilities comparable to reminiscence along with serving to with motor abilities and growing core stability.
The income from classes helps pay for horse feed and veterinary prices, a complication that music therapists don’t face.
“We sit there with a residing respiration animal,” Sliger mentioned. “Now you’re messing with our livestock.”
Katie DeNapoli’s daughters, Serenity, 8, and Savannah, 5, are prescribed equine remedy for his or her autism spectrum dysfunction.
Serenity, who was nonverbal till she was 5, has improved her communication abilities since being round her horse. It took Savannah 4 months earlier than she was comfy sitting on a horse. The talents she gained have made her extra assured, her mom mentioned.
The presence and interplay with these highly effective however light animals awakens one thing in kids with autism who wrestle to acknowledge human communication cues, DeNapoli mentioned.
“It’s one of the vital lovely packages as a result of one thing occurs — I don’t know find out how to clarify it,” she mentioned. “You see miracles on the farm on a regular basis.”
DeNapoli didn’t assume her daughters would perceive the disruption so she informed them that the horses wanted a relaxation. The ladies have requested time and again why they’ll’t be with the horses.
“My kids are very routine oriented; they get confused,” she mentioned. “It messes up their emotional regulation; it’s been a relentless spiral.”
© 2025 Tampa Bay Instances
Distributed by Tribune Content material Company, LLC