States Slow to Move on Mandated ABA Coverage

Months after the federal government passed legislation requiring states to include coverage of therapeutic autism services such as applied behavior analysis (ABA) in their Medicaid programs, progress is slowly being made. 

It was determined in July of this year that Medicaid programs nationwide must cover “medically necessary diagnostic and treatment services” to children with autism spectrum disorders (ASD) including behavioral therapy, occupational and speech therapy, personal care services, and medical equipment. 

California is the first state to comply, issuing a bulletin to plan administrators September 15 explaining that Medi-Cal, California’s Medicaid program, will cover evidence-based behavioral intervention services including ABA for autistic children up to the age of 21. Coverage is available immediately for those who qualify for the program and will be retroactive to July 7, 2014. 

Connecticut and Nevada are expected to be the next states to expand their Medicaid coverage of autism services in compliance with the federal mandate, but no official announcements or timelines have been released. 

Despite warnings from the Centers for Medicare & Medicaid Services (CMS) back in July that it would likely take some time to for states to come into compliance with new regulations, a class action lawsuit has been filed in Hawaii over the state’s failure to provide Medicaid coverage for ABA therapy. We will have to wait and see if this gets the gears of Hawaiian state bureaucracy to move faster and whether similar suits are filed in other states that are slow to comply. 

Navigating Medicaid and obtaining services is complicated and different in every state. Many parents find it much easier to obtain the right services and coverage with the help of local autism advocates and service administrators. Organizations like Shema Kolainu Hear Our Voices School and Center for Children with Autism, serving children in all five boroughs of New York City help parents with Medicaid service coordination, early intervention programs, evaluations, speech therapy, occupational therapy,  physical therapy, and applied behavior analysis.