Navigating the Systems of Care
Navigating the Systems of Care
Written by Arizona Autism United with help from the Arizona Health Care Cost Containment System (AHCCCS)
When you suspect your child may have a developmental delay, it can be difficult to know where to begin. This is where AZA United’s Family Support Team can help. As parents of children with autism, the Family Support Team empathetically understands your journey. We can assist you in finding a diagnostician and navigating the systems of care. When seeking services, it is important to take your funding source into consideration.
If you have private insurance, start by contacting your plan’s benefit department. Many plans cover Speech Therapy, Occupational Therapy, and Physical Therapy. Some plans also cover Applied Behavior Analysis (ABA). If you learn that your private health insurance does not cover these services, you may also reach out to your employer’s HR department for explanations about why they may not be covered. For example, if the plan was underwritten in any state other than Arizona or if the company employs less than 50 employees, they may not be required to cover ABA services.
Applying for government-funded services is another important step for families to ensure your child is eligible for the many services provided through Arizona’s Medicaid program for individuals with disabilities. The Family Support Team at AZA United talks to families every day to help them understand the details of the application and approval process. Visit the How to Access Funding for Services page on our website for important phone numbers and websites.
For families with children under the age of three, call the Arizona Early Intervention Program (AZEIP, pronounced "A-Zip"). Anyone, not just a doctor, can make a referral to the program. If a child is eligible, AZEIP provides service coordination and therapy supports until the age of three years. AzEIP will also work with DDD (see below) to determine if your child is eligible for additional services and supports beyond age three.
Your child may be eligible for Developmental Preschool once they are three years old, but it is important to prepare for this transition a few months before their birthday. The developmental preschool model is generally four days a week for about 2-3 hours per day. If found eligible for Developmental Preschool, your child’s educational team, which includes you, will develop an Individualized Education Program or a 504 Plan. The educational system can be confusing to parents. It is important to know your student’s rights to ensure that your child receives the best education and in-school services possible. Many families are unaware of the benefits of having an IEP or 504 Plan. Raising Special Kids is Arizona’s Parent Training and Information (PTI) Center. Raising Special Kids assists families, at no cost, in understanding and navigating education and services for children with disabilities. They provide information, training, and individual consultations to help parents along their child’s educational journey.
For children over the age of three, call the Arizona Department of Economic Security’s Division of Developmental Disabilities (DDD), a government agency that provides services to eligible Arizona residents who have a developmental disability or other qualifying conditions. The steps to get approved can be complicated, but the Family Support Team at AZA United is available to help.
DDD provides a wide range of medically necessary services. The first step is to contact DDD, who will then review records and other information to determine if your child is eligible. If so, your child becomes a DDD member and your family will be assigned a DDD Support Coordinator, whose role is to identify needs, direct your family to community supports and services, and monitor the progress of your child towards reaching individual goals. However, in order to access the Medicaid funded programs, like therapies, habilitation, respite, etc, your child must also be found eligible through the Arizona Long Term Care System.
The Arizona Long Term Care System (ALTCS, prounounced "All Tex") ") is the state’s Medicaid program that provides the long term care services to DDD members. ALTCS falls under the Arizona Health Care Cost Containment System (AHCCCS, pronounced "Access"). A separate application is necessary for ALTCS since DDD receives federal funds through AHCCCS to provide services to people who may be eligible. Once a child is over the age of 3, approval for funding through ALTCS is necessary to receive DDD and/or Behavioral Health services such as Habilitation, Respite, Attendant Care, Speech Therapy, or ABA to name a few.
When applying for ALTCS, your family must complete both a financial and medical application to determine eligibility for Medicaid funding, also known as Title 19. Please note that the financial eligibility will depend on the income of your child and is NOT based on household income. The medical eligibility is based on a medical interview during which a PAS Assessment is completed. In order to qualify for ALTCS, your child must score 40 points. Please reach out to our Family Support Team if you have any questions about this process. If approved, your child will automatically be assigned a Health Plan. The state’s two ALTCS plans for DDD members are Mercy Care and UnitedHealthcare Community Plan (UHCCP.) The letter you receive with this information will inform you that you have 30 days to change to the other plan if you so choose. The next opportunity you have to change health plans will be the child’s birth month.
Once approved for ALTCS, your assigned DDD Support Coordinator (SC) will schedule a meeting to update/develop your child’s Planning Document, formerly known as Individualized Support Plan (ISP). During this meeting, your SC will determine your child’s needs for DDD services including how long and how often the service should be provided. AZA United’s Family Support Team is available to help you prepare for this process.
Upon completion of the Planning Document, your child will become eligible to receive medically necessary services through AZA United and/or other contracted DDD provider agencies. Many other services are also available including communication devices and personal medical supplies, such as diapers or pull-ups. Please note, diapers/pull-ups (available to children over age three) will require a prescription by the child’s doctor and should be submitted to the supplier by the doctor’s office. This falls under the ALTCS plan, not DDD.
Through the ALTCS/DDD Health Plans (Mercy Care or UHCCP) you child will also be eligible to receive behavioral health services including our ABA Treatment Services as well as our Clinical Family Coaching (Behavior Coaching.) Please note: children who may not be DDD/ALTCS approved, but have an AHCCCS plan are also eligible for these services. To learn more about these services, such as which program may best be suited for your child/family and how to obtain these services through the DDD Health Plan, please contact our Family Support Team.
One other source of funding for therapeutic services is the Empowerment Scholarship Account (ESA) program through the Arizona Department of Education. This program is funded by state tax dollars to provide educational options for qualified Arizona students who choose to opt out of the public school system. Once approved, parents can seek a range of alternative educational services, such as private school or home-based education, to tailor an individualized educational plan that is best for their child. At AZA United, some families choose to utilize their ESA funds to access services such as Speech Therapy and Applied Behavior Analysis (ABA).
AZA United's Family Support Team provides support and guidance for families facing any number of challenges as they navigate the Autism journey. This service is available at no charge to all members of the autism and developmental disability community. You may make a phone appointment that works with your schedule by visiting azaunited.org/supportcall
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Updated 08/07/2020
