Mercy’s exit clause
When autism care becomes a line item … You’re gonna need more schooling … And more human Labubus plz.
Tiana Brandon’s six-year-old son, Micah, trusts a handful of people: his mother, his older siblings, the staff at his autism therapy center and the woman who drives him there.
Micah, who’s nonverbal, has spent three years at Centria’s autism therapy center, where he’s learned shapes, colors and how to communicate his basic needs.
But after Mercy Care, one of Arizona’s Medicaid-contracted health plans, abruptly announced it’s cancelling its contract with Centria, Micah will have to start over at a new center. His mom worries the move could erase years of progress.
“I will be possibly facing all types of regression because they don’t know how to find his cue when it’s time for him to go to the restroom,” Brandon said. “It would just be like starting all over again, completely unnecessary, due to a technicality that has nothing to do with him.”
On Oct. 31, a Centria employee informed Brandon that Micah’s health insurance through Mercy Care will no longer cover services at Centria, where Micah goes every weekday from 8 a.m. to 4 p.m.
Mercy Care contracts with Arizona’s Medicaid program to provide health coverage for people with low incomes. After Centria refused a cut to its payment rates, Mercy Care notified the company that its contract will end in January.
Now, Micah is one of nearly 300 children with Autism Spectrum Disorder who will have to find care somewhere else.
Centria’s lawyers sent AHCCCS, the state’s Medicaid system, a letter alleging that Mercy Care is violating state and federal law by ending the contract and asking AHCCCS to intervene to stop the cancellation.
In its Oct. 17 termination notice, Mercy Care cited a clause allowing it to end its contract “for any reason or no reason at all.” The company opted for the latter.
Centria’s lawyers said they never got an explanation for the reimbursement reductions, and Mercy Care hasn’t responded to the request for an explanation we sent on Monday.
AHCCCS told us they’re looking into the situation.
Mercy Care doesn’t just contract with Centria — it also manages part of Arizona’s Medicaid system under a contract with AHCCCS. State rules require those contractors to get approval and submit an “accessibility analysis” if they make a major change that affects more than 5% of members in a region, or cut ties with the only provider of a specific service in a set region.
Centria’s lawyers argue the rule applies here: As one of Arizona’s largest autism therapy providers, their exit would leave hundreds of families without options and “significantly damage network adequacy.” Plus, the letter says the loss of Medicaid funding means Centria would have to lay off 250 employees.
“This will exacerbate the ongoing shortage of behavioral analysts, and it will make it even more difficult for families and children impacted by (Autism Spectrum Disorder) to obtain the services they need,” lawyers wrote in the request for AHCCCS intervention.
Centria has 17 Applied Behavior Analysis (ABA) centers in the Phoenix and Tucson areas. ABA is one of the most widely used treatments for children with autism.
Still, there aren’t enough autism therapy providers in Arizona to meet the need for them. Last year, job postings for people with the behavior analyst certifications needed to administer ABA therapy increased by 75% in Arizona, one study shows.
Centria’s lawyers indicate they’re not the only autism therapy centers affected.
While “Mercy Care represented that the proposed rate reduction was communicated to all ABA service providers within its network,” the letter alleges that the change “appears to have been selectively directed” to only larger autism therapy providers.
The lawyers also argue that Mercy Care isn’t helping families find new providers.
Brandon, meanwhile, is wary of moving her son. Micah is doing well where he is, but he doesn’t do well with change.
“What if they let me sign him up and collect on him for a couple of months, and then the next thing you know, they’re telling me that he’s not going to be able to attend there either,” she said. “I don’t shop Micah around like that.”
“Very, very frustrating”
To keep her job as a surgical assistant, Brandon pays $800 a month for a driver to take Micah to Centria. It’s worth it — Micah keeps meeting his goals, and Centria allows his occupational and speech therapists to work with him at the center, so she doesn’t have to miss work for more appointments.
So when an employee told Brandon that Mercy Care won’t pay for Micah to go to Centria anymore, Brandon immediately called Mercy Care to try to switch Micah’s plan.
No one picked up after a 40-minute hold. But Brandon got the bad news from AHCCCS a few days later.
Micah is enrolled in AHCCCS’ Arizona Long Term Care System. Only a few other providers besides Mercy Care offer his plan, and recipients can only switch during their birth month.
Micah just turned six in September.
In its legal letter, Centria says parents are asking Mercy Care and AHCCCS for help finding a different autism services provider, but “both Mercy Care and AHCCCS personnel have made disparaging comments to these patients about Centria and, most disturbing, denied their continuity-of-care based transfer requests.”
Mercy Care asked Centria for all of its Mercy Care recipients’ information for “coordination and transition of care” on Oct 22, per an email attached to Centria’s letter, but Brandon said she never heard from her son’s insurance provider.
As a single mom who handles logistics at work, Brandon is used to solving problems under pressure. It’s not her ideal plan, but she’s preparing to move Micah into Gilbert Public Schools’ special education program, followed by an after-school program for kids with autism.
She knows a lot of other parents don’t have that option.
“My kid is not as medically compromised as a lot of kids that are going through this right now. I have friends who have kids who need (tracheostomy) care and feeding tube care,” Brandon said. “What are they supposed to do with these kids? It’s very disheartening. It’s very, very frustrating.”
And the financial strain rippling through Arizona’s Medicaid system is only going to deepen.
The beginning of the end
Mercy Care dropped Centria’s contract after the provider pushed back against a 25% cut in its reimbursement rates.
The attempts at negotiation are attached to Centria’s letter to AHCCCS in an email thread. Centria proposed a 5% rate reduction across all service codes, then offered to cap its clinical hours.
Mercy Care responded with a proposal for percentage-based rate increases for billing more parent-training sessions.
Last week, Phoenix autism service provider Arizona Autism announced it will lay off about 2,800 employees by the end of the year. That was after CEO Ryker Martin organized a September rally at the Capitol to protest reductions to the state Division of Developmental Disabilities program, and Gov. Katie Hobbs ended up postponing the changes.
Still, Martin announced the layoffs because of “evolving market conditions.”
Neither Mercy Care nor Arizona Autism has been willing to give more details than that, but there’s one big, beautiful sign.
H.R. 1, the “Big Beautiful Bill,” limits payments to providers through a series of changes that could take millions out of the state’s Medicaid system in the coming years. AHCCCS is already asking for $71 million next fiscal year to administer new eligibility requirements.
With less federal funding coming in, Medicaid contractors like Mercy Care are incentivized to cut what they pay providers.
Centria’s lawyers note the human toll of those decisions, and point to a 2024 lawsuit to show Mercy Care knows it, too.
The attorneys cite a 2024 court filing from Mercy Care CEO Lorry Bottrill that the company submitted when it sued AHCCCS after nearly losing its long-term care contract.
“Members have already expressed confusion, stress, and anxiety caused by the initial AHCCCS contract award decision…” Bottril writes. “Around half of Mercy Care’s (long-term care) members have a personal representative … they too are stressed due to the confusion and anxiety of a potential health plan change.”
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“The Tonight Show” host Jimmy Fallon gave Arizona Sen. Ruben Gallego a surprise shout-out Monday night — reciting a dreamt-up game of political “telephone” between U.S. senators.
Fallon, cracking himself up the whole time during his monologue, spiraled into a bit where senators kept mishearing each other in increasingly ridiculous ways.
You’ll have to watch the full clip to find out how Arizona’s junior senator ended up talking about Labubus — and yes, it’s as weird as it sounds.
That was so sad. We all knew BBB, (which is a really stupid name for a bill) would cut into Medicaid or AHCCCS in Arizona but to hear a heart wrenching personal story really hit home. It sounds like Centria does more than give health care it also truly educates little Micha. Why couldn’t they call themselves a private school-autism center and get additional money through the ESA program? Ms. Brandon could use ESA money for the school/education center and also charge her $800 a month transportation cost and probably other expenses to the DOE. Tom Horne and the Republicans at the legislature would love that. That’s truly helping children that need specialized education. Wonder how that would work? Probably lots of government/legal speak contract but double dipping into two pots of dollars is what our legislature understands. Salary and per diem, say. Just a thought.