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Friday, July 6, 2018

South Carolina Has Low Medicaid Reimbursement Rates for ABA

The Politics of Autism includes an extensive discussion of insurance and Medicaid services for people with intellectual and developmental disabilities

Lauren Saussner at The Post and Courier that the mother of a six-year in Lexington County, South Carolina is filing a federal suit against South Carolina's Medicaid agency.
Identified in the lawsuit as Z.M., the child's pediatrician recommended in 2015 that he receive dozens of hours of therapy each week, including six consultation hours of applied behavior analysis therapy.

But the lawsuit alleges that Medicaid's reimbursement rates for applied behavior analysis, or ABA, are so low that Z.M.'s parents cannot find a provider willing to offer the therapy their son needs. The lawsuit calls South Carolina's rate "among the worst in the nation."
The agency recently increased its rate to about $31 an hour for this therapy, but last year the department paid about $17 an hour.

The new rate falls far short of most other states.

Lorri Unumb, vice president for state government affairs at Autism Speaks, a national advocacy group, calculated the average rate among 30 states is about $44 an hour.

Both North Carolina and Georgia pay closer to $50, she said.