Minnesota’s Department of Human Services has launched pre-payment audits of Medicaid claims to identify fraudulent charges, but the process is creating severe financial strain for autism service providers serving Rochester-area families. The state identified 14 Medicaid service provider types as high-risk for fraudulent claims, including early intensive developmental and behavioral intervention services that frequently serve youth with autism.
At the Rochester Center for Children, which serves 40 to 50 children in behavioral, occupational, and mental health counseling, director Jon Sailer reported that Medicaid reimbursements have been dramatically delayed. “We were paid $0 for our behavioral therapy work the last two cycles now,” Sailer said, with only partial payment in the most recent cycle—less than half of normal amounts. For RCC, Medicaid accounts for 50% to 60% of total revenues, making these delays devastating to operations.
Momentum Behavior Services, which works with roughly 70 clients in Rochester, Byron, Faribault and Austin, faces the same pressure, with Medicaid comprising 50% to 55% of revenue. The timing is particularly difficult, as delayed payments coincide with the annual January deductible reset for private insurance, when cash flow is typically tight across healthcare providers. The Department of Human Services sends claims to its third-party auditor, Optum, in batches of 104,000 every two weeks, with payments continuing for unflagged claims on regular two-week cycles.
Elizabeth Walby, executive director of the Rochester Area Autism Association, expressed concern that financial strain may force some providers to close or downsize. “They don’t necessarily have the capital to survive if they’re not getting the reimbursements,” she said. Beyond the Spectrum has already paused services in Rochester. Walby warned that fewer providers would extend wait lists for children needing applied behavior analysis therapy, delaying critical early intervention services during a developmental window when such support is most beneficial.
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://www.postbulletin.com/health/minnesota-audit-process-delays-payments-to-rochester-area-autism-service-providers