In what advocates are calling a major win, federal officials are for the first time telling states that Medicaid coverage must include treatments like applied behavior analysis for children with autism.
Medicaid programs nationwide must offer “medically necessary diagnostic and treatment services” to kids with autism, the Centers for Medicare and Medicaid Services told states in abulletin this month. That includes everything from speech and occupational therapy to personal care services and medical equipment, the agency said.
The services must be included in what’s known as the Early and Periodic Screening, Diagnosis and Treatment program, or EPSDT, a package of offerings that every state is required to provide children under age 21 who qualify for Medicaid.
The move comes in response to an increasing number of inquiries in recent years from states facing legal action for denying services to Medicaid beneficiaries with autism, Melissa Harris, director of the Division of Benefits and Coverage at CMS, told members of the Interagency Autism Coordinating Committee recently.
Many of the court cases focused on coverage of ABA therapy, though Harris said that CMS was careful not to single out ABA or any other specific treatment in its directive to states.
“The expectation is children with autism are a population that need to have their service needs met under the state EPSDT obligation. ABA is one way to do it,” Harris said.
Medicaid coverage for kids with autism has traditionally varied from state to state. Establishing national requirements will have a huge impact, advocates said.
“This should be of enormous significance to beneficiaries across the country,” said Dan Unumb, executive director of Autism Speaks’ Autism Legal Resource Center. “It will dramatically increase access to critical, medically necessary care.”