States Move Forward With Expanded ABA Coverage
Months after federal officials ordered them to do so, states are starting to include coverage of treatments like applied behavior analysis for kids with autism within their Medicaid programs.
California is believed to be the first state to roll out the new coverage in response to a mandate this summer from the Centers for Medicare and Medicaid Services.
The federal agency issued a bulletin in July clarifying that Medicaid programs nationwide must offer “medically necessary diagnostic and treatment services” to children with autism including behavior therapy and other offerings like speech and occupational therapy, personal care services and medical equipment.
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In a letter sent Monday, the California Department of Health Care Services told plan administrators that the state’s Medicaid program, known as Medi-Cal, will cover ABA therapy and other evidence-based behavioral intervention services for those on the spectrum up to age 21. The new offerings are available immediately and the coverage is retroactive to July 7 when the federal bulletin was issued, the state indicated.
“With the autism services, this is another way we’re working to make members’ lives better,” said Norman Williams, a spokesman for the California Department of Health Care Services. “It’s something we look forward to providing.”
In addition to California, officials in Nevada and Connecticut are taking steps to expand Medicaid coverage in accordance with the federal guidance, according to Autism Speaks. What’s more, a class action lawsuit has been filed in Hawaii over that state’s failure to provide Medicaid coverage of ABA therapy.
Under the directive from CMS, states were told that services for children with autism must be part of the Early and Periodic Screening, Diagnosis and Treatment program, or EPSDT, a menu of offerings each state is required to provide children under age 21 who qualify for Medicaid.
Melissa Harris, director of the Division of Benefits and Coverage at CMS, told members of the Interagency Autism Coordinating Committee over the summer that it would likely take states some time to come into compliance with the new rules.