The transition of 875,000 children from the Healthy Families program to Medi-Cal began in January; more than 264,000 moved in the most recent phase on April 1.
Since July 1, heath plans have been required to provide these services under state law, but applied behavioral analysis is not a specific covered benefit under Medi-Cal. The controversial and expensive therapy teaches young children with autism and similar disorders how to eat, communicate, play and learn.
Over the past 40 years a large body of literature has shown the successful use of ABA-based procedures to reduce problem behavior and increase appropriate skills for individuals with intellectual disabilities (ID), autism and related disorders. Several review articles and meta-analyses have been published summarizing this large body of literature. ... The large body of literature reviewed in these studies provides empirical evidence indicating that procedures developed using ABA-based principles are effective at assessing and treating a variety of socially important behaviors engaged in by individuals with a variety of diagnoses. Furthermore, ABA-based approaches for educating children with autism and related disorders have been extensively researched and empirically supported (e.g., Howard, Sparkman, Choen, Green, & Stanislaw, 2005; Koegel, Koegel, & Harrower, 1999; Krantz & McClannahan, 1998; Lovaas,1987; McGee, Morrier, & Daly, 1999; Strain & Kohler, 1998)The federal Office of Personnel Management agrees about the evidence behind ABA.
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Senate Bill 946, the law that requires health plans to provide ABA services, exempts Medi-Cal, said Norman Williams, deputy director of California Department of Health Care Services. “That’s why Medi-Cal doesn’t provide it.”
Behavioral health services are available to all Medi-Cal recipients, including those recently moved into Medi-Cal from Healthy Families, Williams said. “However, we are still assessing the specific availability of ABA services.”
Under Medi-Cal, children diagnosed with autism are provided with “medically necessary” services that may include speech, occupational and physical therapy, Williams said. Some children, based on their medical diagnosis, may qualify for specialty mental health services, including ABA.
The Healthy Families program is required to provide behavioral health treatment — including ABA — under the California mental health parity law, according to state regulations.