Funding and Resourcing Services: Part 2 of Promoting Access to Behavior Analytic Services

Please note that this blog is co-written by members of the ABAI Practice Board.

See the ABAI Practice Board website for more information.

Part 1 of this series described who responded to our survey of behavior analysts working in different professions, asking them how they address barriers to care access. For Part 2 of this series, we look at how services are funded and the types of barriers that can make access to services challenging.

Types of Insurance Accepted

63.3% reported working in an industry where services are covered by health insurance. Of those, 76.3% accepted Medicaid and/or Medicare and 89.2% accept some form of private insurance.

The Positive Impact of Insurance-Based Remuneration on Service Access 

Respondents had the opportunity to provide qualitative comments regarding the positive impact insurance remuneration (i.e., pay for services model) has on service access. About one-third of respondents (52) provided statements. 53.8% noted that insurance improved their services’ reach in that third-party payment made services affordable for a diverse range of clients. 32.7% specifically noted that insurance, whether private, subsidized private, or Medicaid, decreased consumer costs in ways that improve equity in accessing services.

Some respondents discussed how insurance, in some instances, helped elevate the standard of care clients access. 23.1% noted that adequate reimbursement rates meant that providers could recruit and retain quality staff from a range of backgrounds and that predictable revenue makes it easier to provide services that are above minimally adequate care. Similarly, 17.3% noted that insurance providers covered a range of services that were important for addressing the multiple needs of clients. A minority of respondents also voiced appreciation for the accountability systems that insurance provides.

The Negative Impact of Insurance-Based Remuneration on Service Access 

Similarly, respondents could also provide commentary on the negative impact of insurance remuneration. Roughly the same number of respondents (57) gave statements on the topic. 40.4% cited low reimbursement rates as a barrier to providing accessible services. This did not include the delay or denial of services during the review process, another challenge that was noted by 28.1% of the respondents.

Related to this, 33.3% also discussed that the specific services that could be provided for reimbursement were very limited, making it difficult for adequate access to be universally provided. Often, this included direct services, such as caregiver training or treatment planning, and barriers to delivering services, such as reimbursement for mileage or telehealth. Likewise, 19.3% critiqued the restriction of services based on certain demographics as a major barrier to equity, specifically those without an ASD diagnosis or exceeding a specific age. 12.3% also acknowledged that the response effort to complete the process for remuneration made it difficult to view insurance as a tool for improving access to services.

A few respondents noted that they operated in an area where insurance did not pay providers directly for services, but they would reimburse families for their costs. So, although reimbursing families for their service costs did aid in improving access to services for some, the upfront costs could serve as a barrier to others. Another respondent noted that government insurance and grants cover the cost of services, however, the waitlist for access services through this method spans several years.