Maura Lerner reports at The Minneapolis Star-Tribune that a 4-year-old from Maple Grove has prevailed in a court case to make Minnesota cover his ABA:
The child, identified only as T.O., and his mother sued the state for refusing to pay for his treatment during a six-month period when his family was in a state-funded managed care plan run by HealthPartners. Under the ruling, HealthPartners must pay for the treatment, which in his case totaled about $25,000, according to Amy Dawson, the family's lawyer.
"I think it's an important victory," said Dawson, founder of the Autism Advocacy and Law Center in Minneapolis.
She said she filed the lawsuit to draw attention to what she called a double standard in the state Medicaid program, a health plan for the poor and disabled.
State officials have said that ABA is not a covered treatment under the rules of Medicaid. In April, however, the Star Tribune disclosed that Minnesota taxpayers have paid millions of dollars for ABA therapy for hundreds of children, many from affluent families. Yet the same coverage is routinely denied to children like T.O. in Medicaid managed-care plans for the poor.
ABA programs offer up to 40 hours a week of one-on-one therapy for autistic children, far more than other forms of treatment.
In her lawsuit, Dawson noted that the state began paying for the boy's ABA treatments after he switched into the disability branch of the program. She argued that the state should have been paying for his therapy all along.
In a ruling dated last week, Judge Louis Thayer agreed.
"The services are identical," wrote Thayer, a judge with the Department of Human Services (DHS), which runs Medicaid in Minnesota.
But, he added: "I lack the authority to address the broader issue of whether [intensive therapy] will always be covered."