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Sunday, April 18, 2021

Zinger in Illinois Law Prevents Medicaid Coverage

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

In the Budget Implementation Act passed in 2019, legislators included coverage for behavioral therapy in the medical assistance program, which administers state and federal funds from Medicaid and similar services to qualifying residents. Any changes in how Medicaid funding is being used must be included in a State Plan Amendment that is submitted to the federal government for approval, which is where the mistake occurred.

The Illinois Medicaid plan requires that a practitioner must be a Board Certified Behavior Analyst, or BCBA, and possess a second credential as either a Licensed Clinical Social Worker or a Licensed Clinical Psychologist in order to receive Medicaid funding for behavioral therapy. That plan was submitted to and approved by the federal government.

A notice from the Illinois Department of Healthcare and Family Services released in October confirmed that dual credentials would be required to receive Medicaid funds through the department for behavioral therapy.

But the Illinois Autism Task Force, based in the Illinois Department of Human Services, warned in a February letter to Gov. JB Pritzker and the General Assembly that “the dual credential requirement will result in devastating barriers to access.” That same letter said only 26 BCBAs possessed one of the other required certifications and it was unclear whether any of the 26 provided behavioral therapy.

The Autism Task Force, in a 2020 meeting, claimed that $42 million placed in the state’s FY 2020 budget for behavioral therapy through Medicaid remained untouched due to the mistake.
HB 16, which currently sits in the House Rules Committee with about five weeks of the General Assembly’s session remaining, would amend the Illinois Public Aid Code to allow for just a BCBA certification for Medicaid coverage of behavioral therapy starting on July 1, the beginning of the 2022 fiscal year.