I was talking to an autism mom the other day while our sons practiced on their Special Olympics basketball team, when I realized I had three other parents waiting to talk to me. Suddenly I’m a wise woman simply because my autistic son is now an adult. We have passed through the Inferno gate of Adult Services but unlike Dante’s, we have not abandoned hope.
But hope was in short supply that Saturday morning. Hot anxiety rose from these parents like steam from a kettle. They rifled through their bags and pockets for something to write on, to take down what I was saying. Every few sentences, one of them would stop me and say, “Wait, what does that mean?’ And every so often, they would stop writing, stare out at the crowded gym and say, “Oh, god, this is so overwhelming. I don’t even know what to do next.”
I could tell her what to do next: everything. Even though her son is around eight, she needed to be planning for his future: job, housing, caregivers. I don’t just mean creating a Special Needs Trust; I mean learning about all the adult services and resources that are available and how to access them.
Just speaking those words makes me go bleary and looking for my bed. But as many autism parents learn early, sleep is something you learn to do without. From the typical sleepless nights of infancy, to the more autism-related sleep disorders that so often develop, to the worry, if you have a child with autism, you think of sleep as a precious gift, not an entitlement.
So I knew these friends of mine would understand it when I told them that in adulthood, there is only one entitlement for our guys: Day Habilitation, also known as DayHab or what it often is, Adult Daycare. The other thing they needed to know is that all roads pretty much lead to Medicaid.
This means you need to know about DayHabs and you need to know about Medicaid. The following is my understanding of Medicaid and how it is used in Massachusetts. Take it with a grain of salt, some of the details are probably incorrect. But if you understand the overall gestalt of what I’m saying, you have mastered the first lesson in Autism Adulthood 101. For the second lesson, you will have to ask specific questions about what you’ve just learned, to adjust my errors, my take on it. So leave that for the second lesson and just learn the first today:
Medicaid dollars are used differently state by state, but by and large they provide services either directly, as in the case of DayHabs which bill to Medicaid as therapeutic programs, or indirectly, as in the case of waivers channeled through the state agencies. In Massachusetts, the waiver money is harder to get, because the state agencies are all competing with one another for this pot of money that goes to the Executive Office of Health and Human Service s. Whereas with the DayHabs themselves, the funding is more directly accessed, from program to money source. So families have to choose a DayHab, but they don’t get to choose which office of EOHHS they are assigned to. And they don’t get any say in how much funding their child receives — if any.
We have to assume that getting funding is going to be a battle. For one thing, there is the increase in numbers: while Nat’s peer group with autism numbered 2 in 10,000 just a decade before him, the two decades after him have seen the number increase to around 1 in 100. So, as hard as it was for Nat to get his funding, it is going to be exponentially harder for the up-and-coming families because there are so many more kids in need! For another thing, the budget is tighter. Some in the Federal Government want to cut or reduce the Medicaid program, strained as it already is. This is largely conservative Republicans, who believe that we autism families, veterans, elderly, homeless families, mental health patients — can all do without. I am so worried about that. I don’t see how this would work. I think it means mostly that families would care for their adult children until they died. Then if they have not been able to find or fund caregivers, the adult child is handled by the state — which means costly institutionalizing. Or worse — living on the streets. But some people have had one experience with someone living off the government who didn’t deserve it and that’s enough to sour them on these programs.
Others, largely Democrats, want to raise revenue to keep Medicaid going. I don’t know if taxpayers who don’t understand the plight of the Medicaid-dependent will feel about that. “Take care of your own,” some say. We do. We try. See above, sleepless nights. Broken families, traumatized siblings, depleted bank accounts. (And don’t you accuse me of bad-mouthing people with autism. I am bad-mouthing the difficulty of doing right by them with so little guidance.)
There will have to be compromises on both sides in order to come out with anything the two agree on. And this means there will likely be less for families with autism.
So parents of younger kids have to figure out now what they can do (and can’t do). They have to plan, like we did, for the worst-case scenario of no funding, and of only some funding. They have to understand that they must advocate with the state agencies while realizing that is the tightest place to go. So just like in an IEP, you go in knowing what are your non-negotiables and what you can live without. Nat needed good caregivers so that was our non-negotiable. Then I would take on the DayHab. I would do what I could to make his days worthwhile, but I was determined that he have his own place to live, with roommates and oversight. I had already seen how he fell apart living here, and the toll it took on my family, Ben especially. I knew that we would not live forever, and I wanted him to be with roommates, and we with other families, to have some kind of net underneath him.
What can parents of non-adults with autism do right now?
1) Find out who your Department of Developmental Services liaison is and make them know you and your kid. Google the number, find out, call.
2) Go to ADDP.org and find DayHabs you want to visit. Get aquainted with what they are like.
3) Learn about Medicaid-funded programs like Adult Family Care (AFC)
4) Get your kid on Section 8 (subsidized housing) waiting lists.
5) Do what those parents did with me: find each other and exchange knowledge. Parents are pretty much the only ones out there who will be glad to help you.
6) Acknowledge that you are going to feel overwhelmed by even just one of these items. Feel it, but then dive in a little bit again.