Another Step Closer to Autism Therapy as Medi-Cal Benefit?

(Getty Images)

(Getty Images)

By David Gorn, California Healthline

CMS officials last week approved a state plan amendment for the state of Washington that includes autism therapy as a Medicaid benefit.

It’s the second state in a month to receive that go-ahead from the federal government, and it means autism coverage should be a Medi-Cal benefit in California, as well, according to Kristin Jacobson, president of Autism Deserves Equal Coverage, a not-for-profit autism advocacy group.

The budget passed this week by the California Legislature omitted autism therapy as a Medi-Cal benefit.

Autism advocates hope one day soon CMS will make it clear that applied behavior analysis treatment — known as ABA therapy — should be a required benefit for all states receiving Medicaid, including California.

It looks as if that day is already here, Jacobson said.

The ruling by CMS in Washington state, and earlier in Louisiana, combine to “clearly establish” that ABA therapy is a Medicaid benefit, Jacobson said.

“It shouldn’t vary from state to state because it’s a federal benefit. The feds have spoken by approving [the benefit coverage] in both Louisiana and Washington. It shows that the Louisiana approval is not somehow a unique situation,” Jacobson said.

California health officials have said they’re watching the cases in other states closely, particularly in Washington, since that state’s rules around autism treatment are similar to California’s.

When CMS gave approval of coverage to Louisiana, state officials here issued a statement about it:

“California and other states are currently awaiting guidance on ABA services from CMS, which we expect to receive soon,” said Norman Williams, deputy director of public affairs for DHCS. “This guidance is what will be used to set policy direction for the inclusion of ABA therapy as a covered Medicaid benefit.”

When asked if the Washington state approval was actually federal guidance, Williams said only that they “continue to await forthcoming guidance from CMS as it relates specifically to California.”

Over two days of inquiry, CMS officials declined to comment for this story.

All of that doesn’t sit well with Jacobson.

“I don’t think any further guidance is necessary. It’s a bit of excuse for them to say they need more guidance,” Jacobson said.

“If it’s an approvable benefit, then it’s a required benefit. … Washington asked for guidance and CMS told them. Louisiana asked for guidance and CMS told them. It’s disappointing that the administration has still been so resistant and keeps wanting more guidance. At this point, they shouldn’t need more,” Jacobson said.

“I don’t think the families can keep waiting. That’s not acceptable, and it’s not legally compliant, either,” she said. “Given the state’s position [acknowledging] the benefits of ABA therapy, it’s unconscionable that they’re not providing it to this population.”

The Louisiana and Washington approvals were prompted by lawsuits. “I hope we don’t have to do that, but we’re not going to rule it out till we see them moving forward for this benefit,” Jacobson said.

Related