Maryland legislation addresses inequities in care under Medicaid

March 31, 2021

The Maryland Legislature has passed two bills addressing burdensome requirements for autism care under Medicaid. These bills are now headed to the Governor’s desk to be signed into law. 

Companion bills, House Bill 598 and Senate Bill 469, pave the way for more meaningful and equitable access to critical autism-related therapies for children on Medicaid. They remove a burdensome and unnecessary requirement within current Maryland Medicaid reimbursement practice, which often has the impact of forcing a parent to choose between paid work or other household duties and ensuring their autistic child receives medically necessary services. This is not a requirement of private insurance plans in Maryland. 

In 2016, Maryland filed a Medicaid State Plan Amendment which added coverage for applied behavior analysis (ABA) therapy for children with an autism diagnosis. That amendment did not include a mandate that a parent or caregiver of children receiving ABA services must be present and available at all times in the setting of that service provision. Unfortunately, because of reimbursement practices, this parent or caregiver presence was still required under Medicaid. 

This has created inequities in access to care since in most families (with typically one or more parents working, a household to run, and sometimes meeting the needs of other children), a parent or caregiver does not have the ability to spend up to 40 hours a week at the site of the child’s ABA therapy. The recently passed legislation addresses these reimbursement practices and disparities in access to care. 

We are grateful for our legislative champions, Delegate Ariana Kelly and Senator Mary Washington who have successfully led these efforts.

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