In The Politics of Autism, I discuss state Medicaid services for people with intellectual and developmental disabilities.
In 2014, CMS advised states that they must cover medically necessary care for Medicaid-eligible children with autism up to age 21. Advocates say that includes therapies a doctor deems necessary for a child, including behavioral analysis, which uses positive reinforcement to encourage behavioral modification and can run from $60 to $150 an hour.
Some states – California, Virginia and Maine, for example – needed very little prodding to put policies in place. Others, including Ohio and Florida, did so only after being hit with court suits.Shylo Bundy sought Medicaid for her daughter, and got a reversal of a denial.
After her success, Bundy began a pro bono effort to help a handful of other families get Medicaid coverage, too.
In 2015, she and others were having regular meetings with legislators and Texas Health and Human Services officials. Bundy said she thought state officials were gearing up to add behavioral therapy to standard Medicaid coverage for children with autism, which generally includes occupational, speech and physical therapy.
But that stopped after the Legislature last year did not pass a bill to license behavioral therapists. Legislators opposed licensure for several professions, saying it was overregulation. Shortly afterward, the state stopped covering autism behavioral therapy.
“The state had said what would make them feel better about Medicaid covering ABA was if [therapists] were licensed,” Bundy says. “It’s not required under Medicaid law, and many other states provide ABA without licensure. But we were working on getting a licensure bill passed. When it didn’t pass, the state cut all those people off [from ABA].”
Bundy says that the state had approved only 10 children for the therapy – including her daughter — and all but two were left without the therapy. State officials have not made clear why coverage continues for those two.