The Politics of Autism includes an extensive discussion of insurance and Medicaid services for adults with intellectual and developmental disabilities. Cases of fraud and overbilling have led to a backlash.
Where it stands: States and Medicaid managed care plans are scrutinizing more autism program spending and imposing cost controls.
- Nebraska cut Medicaid payments for applied behavioral analysis by up to 80% last year. Indiana policymakers have proposed payment caps and reduced rates. New York is considering legislation that would make similar changes.
- Medicaid managed care insurers like UnitedHealth Group have also limited coverage for applied behavioral analysis in some states.
Yes, but: The changes are causing significant upheaval for families that have been using applied behavioral analysis.
- One mother in Arizona told Axios Phoenix that her 3-year-old son spent eight months on a waitlist for services before he got into a program last year.
- Their insurance plan has since removed the provider from its network. The mother said she'll probably have to quit her job when her son loses coverage for his 40-hour-a-week therapy in May.
- North Carolina reversed some cuts to Medicaid payment for applied behavioral analysis services last year after families of kids with autism sued the state.
