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Medi-Cal Funding For ABA Fails, But New Option Emerges

June 13, 2014

SACRAMENTO (June 13, 2014) -- A $50 million appropriation sought for Medi-Cal to provide behavioral health treatment for autism failed to make the final cut in California's state budget negotiations. But the Department of Health Care Services (DHCS) will be directed to incorporate the treatment in Medi-Cal, which is the state's Medicaid program, and request the Legislature for an appropriation.

"We are disappointed that this appropriation failed, depriving hundreds of California children with autism with access to medically necessary treatment that can make an enormous improvement in their quality of life," said Kristin Jacobson, state policy chair for Autism Speaks. "This is particularly frustrating given the acknowledgment by at least two state agencies that delaying treatment causes irreparable harm.

"However, we take heart in the Legislature's directive to DHCS to right this wrong by building the benefit into Medi-Cal," she added. "We commend Senate President pro Tem Darrell Steinberg (left) for his continued leadership on behalf of the California autism community."

The issue arose in 2013 when the Healthy Families program was shuttered, resulting in the transfer of thousands of children into Medi-Cal. Children who were receiving Applied Behavior Analysis (ABA) behavioral treatment in Healthy Families lost the service when they entered Medi-Cal.

An attempt was made in the recently concluded state budget negotiations between the Legislature and Gov. Jerry Brown to add a $50 million Medi-Cal appropriation to restore the coverage, but it failed to make the final agreement. In its place, behavioral health treatment was determined to be a Medi-Cal benefit and DCHS, which administers the program, was directed to start the administrative process of including it.

That process will require outreach to federal Medicaid authorities as well as stakeholders. DCHS would need to seek statutory authority on how to implement the new benefit, and determine eligibility criteria, provider participation criteria, utilization controls and a delivery system structure. The department would be required to develop an appropriations request, conditioned on assurances of federal financial participation.

The Legislature directed DHCS to add the benefit when it is federally required.

"We believe ABA coverage is already required under Medicaid given successful lawsuits in other states, such as Florida, and the federal government's recent approval of ABA benefits added by Louisiana and Washington state," Jacobson said. "The Louisiana and Washington plans now cover behavioral health treatment as a benefit under EPSDT (Early Periodic, Screening, Diagnosis and Treatment).

"EPSDT benefits may not vary from state to state, so if the benefit is valid in one state it should be required in all states," she said.