How UnitedHealth’s Playbook for Limiting Mental Health Coverage Puts Countless Americans’ Treatment at Risk
ProPublica has obtained internal documents showing that UnitedHealthcare is aggressively targeting the treatment of thousands of children with autism across the country in an effort to cut costs. This secret playbook, developed by Optum, the division that manages mental health benefits for UnitedHealth, outlines a strategy to limit children’s access to applied behavior analysis (ABA) therapy. This therapy has been shown to be the “evidence-based gold standard treatment” for those with medically necessary needs.
The documents reveal that Optum is pursuing market-specific action plans to restrict children’s access to therapy, including preventing new providers from joining the network and terminating existing ones. This would result in patients having to find new clinicians that accept their insurance or pay out-of-pocket for the therapy, which can cost tens of thousands of dollars a year.
The strategy targets children covered by the company’s state-contracted Medicaid plans, funded by the government for the nation’s poorest and most vulnerable patients. Optum expects to spend about $290 million for ABA therapy within its Medicaid plans this year, but anticipates a need for increased spending.
To achieve this cost-cutting goal, Optum is developing a rigid utilization management approach, which can lead to denials of covered treatment. The company has calculated that in some states, this reduction could impact more than two-fifths of its ABA therapy provider groups in the network and up to 19% of its patients.
Experts and advocates have expressed outrage over the company’s strategy, calling it “unconscionable and immoral.” They argue that limiting access to treatment and shrinking the network can lead to serious consequences for children’s health and well-being.
The findings are particularly concerning for children like Benji, who has severe autism and relies on ABA therapy to communicate and manage his behavior. His mother, Sharelle Menard, is worried that if his therapy hours are further reduced, his progress will stagnate, and he will face increased frustration and potential harm to himself and those around him.
The situation is even more dire for children who are already struggling, as ProPublica has learned. Inside the insurance company, the strategy to limit treatment may be violating federal law, with some experts predicting that the long-term cost savings could be outweighed by the increased costs of supporting untreated or undertreated patients.
The story raises concerns about the impact of the private insurance industry on America’s mental health care system, as well as the implications for children with autism and other developmental disorders.