Medicaid Coverage for ABA By States Accelerates

In response to federal directive, states adding ABA coverage, facing litigation

September 15, 2014

NEW YORK (September 15, 2014) — In response to a July directive from the federal government to step up Medicaid-funded treatment for autism, a number of states are quickly moving forward to add benefits for behavioral health treatment. One state–Hawai’i–has been hit with a class action suit for failing to provide the coverage.

The Autism Speaks Legal Resource Center (ASLRC) has been working with advocates and state officials from around the country on implementing the July 7 directive from the Centers for Medicare & Medicaid Services (CMS), said Dan Unumb, ASLRC’s executive director.

One-third of all children with autism receive primary insurance coverage through Medicaid; including secondary coverage, half of all American children with autism are impacted. Medicaid is a joint federal/state program.

“This a game-changer for the autism community,” Unumb said. “How soon this will play out in each state and kids get treatment remains to be seen, but the ball is moving down the field.”

Among the highlights since the CMS announcement was issued:

  • California has moved forward with plans to require coverage of behavioral health treatment, including applied behavior analysis (ABA), starting Monday. An estimated 12,000 children will gain coverage through Medi-Cal, including 6,000 who currently have no coverage for treatment.
  • Nevada is hosting a public workshop today to start implementing behavioral health treatment coverage through its Medicaid program. Based on the public input and further review, the state will submit a Medicaid plan change to CMS for approval.
  • Connecticut Gov. Dannel Malloy has directed his administration to develop a “full range” of autism treatments, including ABA, to be covered through the state’s Medicaid program. Further details are to be provided in October at a meeting of the Autism Spectrum Disorders Advisory Council.
  • A federal class action suit has been filed against Hawai’i for denying ABA benefits through its Medicaid program for autism treatment. The complaint, Egan v McManaman, estimates that 1,500 to 1,900 children under the age of 21 would be affected.


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