A new way to bill Medicaid for behavior analysis has some parents of children with special needs and their caregivers concerned.

They say they're worried it could compromise and limit therapy access, leading to coverage by less qualified caregivers.

Organizers with rallies held in the Bay Area in opposition to the change, said they are attempting to get the attention of the Florida Agency for Health Care Administration, which oversees and administers Medicaid. Despite the public outcry, the new billing codes went into effect on Aug. 1

Board Certified Behavior Analyst, Andrea Holladay, said that some therapy previously billed based on the provider's level of education can now be charged at an entry level rate, which would mean a drop in pay for some caretakers.

"The way that would impact if, say, that person is a behavior analyst and they have received their credentials and they are now providing direct therapy," she said. "It’s basically a reduction of our hourly rate by about 36%."

Julie Dang-Martinez said she has seen the impact of behavior analysis therapy first-hand. This type of treatment started with her daughter, Tyanna, as a minor and has continued into adulthood. Dang-Martinez was hopeful that other families will be about to continue to benefit.

Diagnosed at birth with a rare genetic disorder, she credits Tyanna's growing independence on consistent care from experienced professionals.

She said support from caregivers, like a personal support coach and a Board Certified Assistant Behavior Analyst, have had a significant impact on Tyanna and the entire family.

"It’s just been day and night as far as our standard of living and our family’s mental health," said Dang-Martinez.

Melanie Donnelly, a Board Certified Assistant Behavior Analyst, has been with the family more than five years.

"She’s learned quite a few skills with us as far as independent living skills," said Donnelly.

Skills like communication and daily living — laundry and watering the plants are some of Tyanna's household chores, Dang-Martinez said.

Donnelly says continual support helps keep Tyanna on track.​

"She’s becoming more independent and needing less prompts from mom or from us to where she can go through this process independently," she said of Tyanna. "And that’s ultimately our goal, is to get them to do it all themselves so that mom has a little more time and that they can learn to do things themselves.

Feeling comfortable with the level of care Tyanna has received over the years, Dang-Martinez said she feels confident heading to her photography studio for work.

"I make my own hours," she said. "The longest day that I have from start to finish is about six hours, and then I can take breaks, I can go home and check on her, come back, I can kind of do my own schedule."

The things Dang-Martinez says she loves about photography are confidence, and the ability to capture a moment in time.

It's that same confidence she wants her daughter to maintain.

Whether it's learning through praise when goals are met, or completing her chores, Dang-Martinez says the therapy that started when she was a child has continued into adulthood.

But new coding for how Medicaid bills behavior analysis therapy continues to cause concern for some parents and specialists concerned.

"They’re not going to have someone there who is as qualified, there’s going to be less help for them," said Donnelly.

While officials with the Florida AHCA say the changes should not have an impact on services, not everyone is convinced.

"Even just limited, it will cause such a huge disruption in behaviors and family dynamics, as far a having good behaviors dealing with conflict and communicating that," said Dang-Martinez.

That communication is something that can help the entire family, she said.

"The quality of life that she has now, the mental health that she has is because of behavior analysts that were able to come in and help me know what triggers to put in, or what steps to put in place, for her to do well day to day," said Dang-Martinez.

With Tyanna gaining more independence, Dang-Martinez hopes other families can rely on the same type of therapy that continues to help her family.

AHCA officials say the changes are not a pay cut for providers and should have "zero impact" on services.

The agency did not respond when asked about the concerns from caregivers about how pay was now being coded without taking credentials into account.