Urge Medicaid to comply with 2014 law to cover ABA for Autism

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It's time for Medicaid to do the right thing and start following the 2014 mandate to cover ABA therapy!!

In July of 2014, the federal Centers for Medicare & Medicaid Services (CMS) issued a written bulletin specifically reiterating states’ obligation to cover all medically necessary treatments for autism for children and young adults, based on individualized determinations of medical necessity. This may include ABA treatment, speech, occupational and physical therapies, and other therapies and devices depending on the individual needs of the child.


The federal act mandates that all states provide Early Periodic Screening Diagnosis and Treatment (EPSDT) services for all Medicaid eligible children under 21 years of age. The broad EPSDT mandate requires that states provide all coverable medical assistance to correct or ameliorate defects and physical and mental illnesses and conditions in these children even if that care is not currently in the state’s Medicaid plan. However, at this time, Medicaid does not credential Board Certified Behavior Analysts who are the only qualified providers of ABA and the Medicaid system does not accept the Universal ABA CPT Codes, therefore preventing providers from submitting claims for services rendered to Medicaid beneficiaries with Autism.


We know the funding is available to cover these services and it's clear that the issue comes down to funding priorities. Our ASD kids and adults are simply NOT a funding priority at Medicaid. Make us a priority and have Medicaid start adding Board Certified Behavior Analysts as credentialed providers and accepting the universal CPT codes for ABA. If they do not commit, a team of attorneys are prepared to file suit in order to convince Medicaid to do their job and honor the mandate.
We understand that Medicaid pays for various elective procedures such as vasectomies so we want Medicaid to find it in their hearts to cover individuals with medically-necessary treatments, like ABA therapy.



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