Medicaid and Behavioral Treatments

Autism Speaks reports:

In a major victory for Medicaid coverage of autism, a federal agency has directed the states to cover medically necessary treatments for autism for children and young adults, including behavioral health treatments such as Applied Behavior Analysis (ABA). An estimated one-third of all children with autism receive primary coverage through Medicaid. 

The announcement by the Centers for Medicare & Medicaid Services (CMS) makes clear that autism treatment must be addressed under Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services which cover Medicaid-eligible children up to the age of 21. 

Dan Unumb, the executive director of the Autism Speaks Legal Resource Center, said the new CMS guidance "is extremely useful in providing a road map for Medicaid coverage of autism treatments, including ABA, and admonishing the states that their obligation to provide all necessary medical care under EPSDT applies with full force to children with ASD.”