(August 26, 2014) - Kaiser Health News (KHN) has examined how the states are reacting to the federal government's July directive to cover medically necessary treatments for autism for individuals under age 21. An estimated one-third of all children with autism receive primary coverage through Medicaid.
The announcement by the Centers for Medicare & Medicaid Services (CMS) makes clear that autism treatment must be addressed under Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services which cover Medicaid-eligible children up to the age of 21. The states are now assessing how to implement the change.
While coverage of applied behavioral analysis "isn't explicitly required" by the new guidance, KHN noted, advocates expect it to be covered.
"Since ABA is the most accepted, effective treatment that isn't experimental and investigational, you can't just exclude it entirely," Daniel Unumb, executive director of Autism Speaks' Legal Resource Center told KHN.
In California, where the state has already begun steps to expand Medicaid coverage, an additional 6,000 children with autism could benefit under the new federal guidelines, said Kristin Jacobson, co-founder and president of Autism Deserves Equal Coverage.
“For them it’s going to be a huge deal,” said Jacobson, who worked with Autism Speaks to help enact California's 2011 autism insurance reform law.
Unumb said over a dozen states had reached out to him for guidance on how to implement the new directive.