We, the undersigned parents, caregivers, and advocates of children with Autism Spectrum Disorder (ASD) in Massachusetts, respectfully petition for immediate policy and practice changes regarding the denial of Home Health Aide (HHA) services for autistic children enrolled in WellSense plans, including the WellSense Boston Children’s ACO.

THE PROBLEM

MassHealth and its contracted Accountable Care Organizations, including WellSense, routinely deny prior authorization requests for Home Health Aide services for children with autism. Common denial reasons documented in Board of Hearings decisions include:

• Presence of a parent or family caregiver in the home (130 CMR 403.409(D) – “Availability of Other Caregivers”)
• Characterization of needs as primarily supervisory, behavioral, or long-term rather than intermittent skilled care
• Assertion that the Pediatric Personal Care Attendant (PCA) program is the more appropriate vehicle

These denials leave families without critical in-home support for activities of daily living, safety supervision (including elopement risk), personal care, and behavioral regulation—supports that are medically necessary for many children with ASD.

A CONCRETE EXAMPLE

One Massachusetts parent of a child with autism has made extensive, documented efforts to obtain medically necessary Home Health Aide services. These efforts included:

• A formal peer-to-peer clinical review with the child’s pediatrician
• Submission of a comprehensive 22-page packet of recommendations and evidence-based statements from the child’s medical providers, teachers, and school staff

Despite this substantial clinical documentation, the request was still denied. This experience is not isolated — it illustrates the systemic barriers many families of autistic children continue to face under current WellSense / Boston Children’s ACO prior-authorization practices.

IMPACT ON FAMILIES

• Caregiver burnout and inability to work or maintain employment
• Increased risk of injury, elopement, or institutional placement
• Unequal access to community-based care compared to children with purely physical disabilities
• Disproportionate burden on single parents, parents of multiple children with special needs, and families already navigating IEPs, ABA therapy, and other systems

WHAT WE REQUEST

1. Immediate review and revision of medical necessity criteria and prior authorization practices for pediatric HHA services so that autism-related functional, safety, and ADL needs are properly recognized.

2. Clear guidance that the existence of a parent caregiver does not automatically disqualify a child from medically necessary agency-provided HHA services, especially when parental capacity is limited by employment, health, or multiple caregiving responsibilities.

3. Better coordination and seamless transition pathways between HHA and the Pediatric PCA program so families are not left without services during evaluation or appeal periods.

4. Transparent data on HHA and PCA approval/denial rates for children with ASD diagnoses under WellSense and other MassHealth ACOs.

5. Engagement with parent advocates, developmental pediatricians, and autism organizations to update policies so they reflect the real-world needs of autistic children and their families.

We call on WellSense, Boston Children’s Hospital, MassHealth, and the Massachusetts Legislature to act now so that autistic children can safely remain at home with the supports they need.

• WellSense Health Plan
• Boston Children’s Hospital / WellSense Boston Children’s ACO
• MassHealth / Executive Office of Health and Human Services
• Massachusetts Joint Committee on Health Care Financing
• Massachusetts Joint Committee on Children, Families and Persons with Disabilities