New Texas ABA Medicaid benefit takes effect February 1January 28, 2022
Effective February 1, 2022, Applied Behavior Analysis (ABA) is a covered benefit for Medicaid enrollees in Texas who have autism spectrum disorder (ASD). This new ABA Medicaid benefit has taken years of advocacy by Autism Speaks and advocates across the state who care about making Texas a better place for those affected by autism.
ABA is the acronym for "Applied Behavior Analysis." It is an evidence-based behavioral therapy for those with ASD and one of the most common interventions for people with autism. Learn more about ABA.
The path to coverage under Medicaid for ABA services has been long and not without its challenges. On June 15, 2019, Governor Abbott signed the budget bill which included a requirement for Texas Medicaid to cover medically necessary care, including ABA, for all Texas Medicaid-enrolled children. Unfortunately, due to COVID-19, the implementation of coverage for autism services was delayed. During this time Autism Speaks has continued to work toward effective implementation, and we are now happy to share more information about how to access and use the new benefit.
Details about accessing the Medicaid ABA benefit:
- The individual enrolled in Medicaid must be under 21 years old. Currently, CHIP enrollees are not eligible for the benefit. However, Medicaid Buy-In enrollees are eligible. To learn more about Medicaid and the Medicaid Buy-In program, visit here.
- The individual needs to have been diagnosed with ASD within the last 3 years. The diagnosis needs to include a classification of the child as “Level 1,” “2” or “3.”
- A doctor or other medical professional (for example, a psychologist or nurse practitioner) needs to make a referral (prescribe) ABA for the child. The referring medical professional must be an enrolled Medicaid provider.
- ABA providers who are accepting Medicaid clients will be in the online provider directory of the child's health plan (administered by a Texas Managed Care Organization/MCO). Search for "licensed behavior analysts” or “autism services.” Check the back of the child’s Medicaid card for MCO plan information.
- Translation/interpreting services are required to be provided for clients and their caregivers who need such help. The MCO is responsible for arranging and providing such services. The MCO should be contacted using the information on the back of the client’s Medicaid card to request language support.
- Because ABA is a brand-new Medicaid benefit, we expect there may be some hiccups along the way as it is rolled out. We also expect that there will be a shortage of providers who are accepting Medicaid clients. For these and other concerns, please contact the child's Medicaid service coordinator or the state's Managed Care Ombudsman and ask for help. Texas families have waited so long for this benefit & we want to help the state address any problems as quickly as possible.
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