Montana’s Medicaid benefit changes to provide more children with autism the treatment they need

September 6, 2022

Exciting changes have come to Montana’s Medicaid Program for those children with autism! In 2017, Montana began covering Applied Behavior Analysis (ABA) when prescribed for children with autism who are served by Medicaid. But in the years since, state officials grew concerned that too few eligible children were using the benefit. The state initiated a careful analysis, including a stakeholder survey and provider focus groups, As a result, a re-vamped program was announced earlier this year with a focus on expanded eligibility and treatment flexibility.

Highlights of changes:

Expanded eligibility – now included are:

  • Children with a provisional ASD diagnosis.
  • Children who have been identified as eligible for the state’s Developmental Disabilities Program.
  • Children with a qualifying mental health diagnosis (those categorized as Serious Emotional Disturbance in the state’s Clinical Guidelines).

Easier to begin services:

  • No prior authorization is needed to begin services.
  • A child will not need authorization for services for the initial 180 calendar days or 1,260 units (a unit is 15 minutes of treatment).
  • The provisional diagnosis referenced above can be made by any physician, licensed mental health professional, or “other qualified healthcare professional.” (However, an ASD diagnosis that is not provisional must be ascertained by a more narrowly trained professional developmental pediatrician, psychiatrist, or psychologist.)
  • A provisional diagnosis is acceptable for the initial 180 calendar days or 1260 units (whichever is used up first).
  • Authorization is required to continue ABA services beyond the initial 180 days/1260 units and is based on evaluation and subsequent diagnosis of ASD plus documentation that the person is showing progress as a result of treatment.

Increased flexibility in the administration of a child’s treatment program:

  • Now, in addition to community settings, services can be provided in a clinic/office or home.
  • Parents/caregivers are now not required to be present for treatment unless the parent/caregiver training portion of treatment plan is being implemented.
  • Board Certified Behavior Analysts (BCBAs) can now decide which assessment is most appropriate for each child in the development of the treatment plan.
  • BCBAs now have a “package” of units to use across treatment services for the child, and there is a process for requesting more during a period.
  • Services can now be delivered in a group setting.

The benefit’s name was also changed from Autism Treatment Services to Applied Behavior Analysis (ABA) Services.

Additional details on the benefit are here. A video presentation on the new benefit, including a presentation transcript, is available.

To find providers who serve Montana clients with Medicaid, use the Provider Directory.

Some tips on navigating the Provider Directory:

  1. Search by Provider Type
  2. Filter by Category: Behavioral Health and Social Service Providers
  3. Filter by Specialty: Behavior Analyst
  4. Don’t make a selection for Filter by Program
  5. Location: enter client’s City, State, or Zip Code
  6. Location:  adjust miles to indicate how large of a radius to travel is acceptable
  7. Select Find Providers

As of April 2022, Montana Medicaid served approximately 117,475 individuals (under age 21) throughout the state. The CDC estimates that approximately 1 in 44 or 2.3% of 8-year-old children are autistic. These Medicaid changes will benefit many children with autism in Montana in need of quality care and services.