Medicaid Now Required to Cover Autism Services

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The Centers for Medicare & Medicaid Services announced in July that comprehensive autism services must be covered for children under all state Medicaid and Children’s Health Insurance Program (CHIP) plans, a report published in MedPage Today indicated.

The new policy will require mandatory coverage of autism services for everyone under age 21, according to Kristin Jacobson, co-founder and president of Autism Deserves Equal Coverage.

Medicaid programs must adhere to the early and periodic screening, diagnostic, and treatment services provision of the law. This covers any services that are medically necessary to correct or ameliorate physical or behavioral conditions in children up to age 21.

The Association of Maternal Child Health Programs estimates that approximately a third of children with autism spectrum disorder (ASD) receive coverage through Medicaid or CHIP.

The new coverage rules have been in effect since July 7, 2014, but many states are still putting procedures into place. Though some states are concerned about costs, advocates argue that early intervention can save money in the long run. Almost half of all children with ASD who receive early interventions can achieve mainstream status, according to a 2005 study published in the American Journal of Mental Retardation.

Currently, 37 states and the District of Columbia have passed laws that also require private insurance to cover autism treatment.

Federal Officials Order Medicaid To Cover Autism Services
Federal Officials Order Medicaid To Cover Autism Services

When Yuri Maldonado's 6-year-old son was diagnosed with autism 4 years ago, she learned that getting him the therapy he needed from California's Medicaid plan for low-income children was going to be tough. Medi-Cal, as California's plan is called, does provide coverage of autism services for some children who are severely disabled by the disorder, in contrast to many states which offer no autism coverage.

Medi-Cal, as California's plan is called, does provide coverage of autism services for some children who are severely disabled by the disorder, in contrast to many states which offer no autism coverage. But Maldonado's son was approved for 30 hours a week of applied behavioral analysis (ABA), a type of behavior modification therapy that has been shown to be effective with autistic children, and she was worried that wasn't enough.
 

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