Medicaid coverage of autism services ordered by CMS

Lana Bandoim's picture
Autism medicaid coverage

Families who have requested help for autism services from Medicaid are getting a glimmer of hope. Each state previously had its own rules that often left families struggling to pay for services on their own. Now, the Centers for Medicare & Medicaid Services (CMS) is making significant changes that will affect all the states.

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Medicaid coverage for children with autism has been an issue in many parts of the United States. Families have experienced problems ranging from complete denial of services to limited help with payments. Some states would only provide coverage if the child was severely disabled, so there were kids being left out.

The Centers for Medicare & Medicaid Services has issued a bulletin that provides important information about coverage for autism services. States are being ordered to cover all children under the age of 21 with autism spectrum disorder. This means they can no longer deny help to kids who may be considered higher functioning on the spectrum but still need services. Low-income families will benefit the most from these changes, but experts hope the laws will encourage private insurance companies to also increase their coverage due to demands.

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Autism behavior therapy is an important part of treatment that should not be ignored because it can have a dramatic impact on a child’s future.

The response from some of the states to the changes has been mixed because there are concerns about rising costs with increased coverage. However, parents are thrilled to see Medicaid being forced to modify its guidelines at the state level, so children on the spectrum can finally get the services they need. More children will finally have access to the common form of help known as the Applied Behavioral Analysis (ABA) treatment. ABA is expensive, and Medicaid has resisted covering it in the past.

Image: Melesse/Wikimedia Commons

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Comments

When will these changes take effect ?