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ASAN Releases New Resource On Medicaid Coverage for Autism Services

ASAN has released a new resource for its toolkit on health coverage for autism-related services. The resource, which is aimed at Medicaid plan administrators, will help plan administrators develop and expand coverage for autism services such as communication supports, occupational therapy, and speech therapy. ASAN released a resource on Medicaid coverage for individuals and families this July.

ASAN’s resource for Medicaid plan administrators will help supplement existing guidance on coverage for autism services. Even after the Centers for Medicare and Medicaid Services (CMS) released guidance on Medicaid coverage for autism-related services, administrators often do not know what types of services they can cover, what the appropriate licensing and oversight measures are for each type of service provided, how to maintain a network of providers of autism services in the state and when to use out of state providers, and how to determine when a particular benefit is “medically necessary.”

ASAN has found that many providers are under the false impression that they are only required to cover Applied Behavioral Analysis (ABA), which does not address the sensory, emotional, communication, or other concerns that may have a significant impact on an autistic person’s quality of life. This lack of clarity can create wide disparities between the types of autism services provided under state Medicaid plans. Medicaid plans are legally required to cover the full range of medically necessary services to children and adults under age 21.

ASAN’s resource on health insurance and Medicaid coverage for autism services includes:

  • A Guide for Medicaid Providerswhich discusses the many barriers there are to effective implementation of health care plans for autism spectrum disorder (ASD) and provides guidance to health care providers on how they can overcome the barriers. It provides an overview of all federal laws and regulations that address what services Medicaid providers are required to fund and why. It also outlines several policy recommendations, including information on alternative, clinically proven interventions which historically lacked funding and suggestions on how to implement stricter quality control measures.
  • Model plan languagewhich provides an effective example of a health care plan that would cover a wide range of effective therapies for autism spectrum disorders.

ASAN’s toolkit on the available health care coverage for autism services is the third of four toolkits for advocates on health care issues facing the disability community. These toolkits were made possible by funding from the Special Hope Foundation. To read more about this toolkit, including our resource for individuals and families, visit http://autisticadvocacy.org/policy-advocacy/policy-advocacy-toolkits/healthcoverage/.

We hope that you find our toolkit useful and distribute it widely. Please send any concerns, feedback, or comments on how you plan to use the toolkit to ASAN’s Director of Public Policy, Samantha Crane, at scrane@autisticadvocacy.org.

Thanks to generous support from:

Logo for the Special Hope Foundation     icdl

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