The Politics of Autism includes an extensive discussion of insurance and Medicaid services for people with intellectual and developmental disabilities.
In 2014, the Centers for Medicaid and Medicare Services issued a bulletin telling states to pay for “medically necessary diagnostic and treatment services” for kids with autism, but stopped short of directly requiring ABA therapy.
However, advocates say that because some children on the spectrum require ABA, every state should offer coverage to those who do. Most states have since done so, but some legislatures have not allocated funding, even though they’ve passed laws that require private insurers to cover ABA therapy.From Autism Speaks:
The states that do not offer ABA therapy to all children who meet medical necessity criteria are: Idaho, Illinois, Maine, New Jersey, New York, Ohio, Oklahoma and Texas. ABA therapy uses reward-based motivation to help children with autism learn new skills and reduce harmful behavior.
The Texas state legislative session has begun, along with our advocacy efforts to ensure autism coverage for Texas children on Medicaid!
An estimated 80,000 Medicaid-enrolled Texas children are diagnosed with autism spectrum disorder. However, most are unable to access evidence-based treatments for their diagnosis.
Timely access to medically necessary treatment, including applied behavior analysis (ABA), is critical for children diagnosed with autism.
Under the Early Periodic Screening, Diagnostic, and Treatment (EPSDT) Medicaid benefit, children under the age of 21 are entitled to any treatment, procedure, or service that is medically necessary to address health conditions of a child.
In July 2014, the Centers for Medicare and Medicaid Services (CMS) issued a bulletin telling states to add coverage of medically necessary autism treatments for children in their Medicaid plans. Since then, more than 40 states have moved forward in the addition of this coverage.Texas is one of the few states to have NOT yet added coverage.
A solution is moving forward in the Texas legislature this session. The Texas Health and Human Services Commission has included the addition of this autism health benefit as Exceptional Item 44 in their proposed budget.
The proposed budget must be approved by the Texas state legislature.