A federal judge has ordered Florida's Medicaid program to immediately cover applied behavior analysis (ABA) for children with autism "to prevent irreversible harm to these children’s health and development." The Autism Speaks Legal Resource Center filed a friend-of-the-court brief in the case on behalf of the children.
U.S. District Court Judge Joan A. Lenard originally issued the order in March 2012 in a lawsuit, Garrido v Dudek, demanding, “How many children were lost?” The suit was brought on behalf of several Florida children with autism on Medicaid against the Florida Agency of Health Care Administration (ACHA), which administers the state's Medicaid program.
An appeals court upheld the order in September, but directed Lenard to amend her ruling to make clear that ACHA can make eligibility determinations for ABA coverage on a case-by-case basis.
Lenard issued a permanent injunction last week, directing ACHA to immediately provide ABA to the plaintiffs, to notify all community behavioral health services providers enrolled in Medicaid that ABA is now covered for children diagnosed with autism, and to notify all physicians enrolled in Medicaid who provide EPSDT screens that ABA is now a covered service.
In her ruling, Lenard found the ACHA failed to follow its own procedures, relied on an insurance industry-funded study to debunk ABA, failed to obey a mandate from the Legislature to pursue Medicaid waivers, and determined that ABA was "experimental" on the basis of being sued rather than careful analysis of medical literature. ACHA determined that ABA was experimental shortly after the lawsuit was filed in 2011.