Long-Sought Autism Therapy A Medi-Cal Benefit, State Says

(Getty Images)

(Getty Images)

By David Gorn, California Healthline

State officials Tuesday said autism therapy clearly is a covered Medicaid benefit, and they hope to submit a state plan amendment by Sept. 30 to start the process to make it a benefit for those under age 21, enrolled in the state’s Medi-Cal program. Medi-Cal is California’s version of Medicaid.

According to René Mollow, deputy director of benefits and eligibility at the Department of Health Care Services, Medi-Cal children are entitled to applied behavior analysis — known as ABA therapy.

“Right now we’re working on the development of a state plan amendment. We want to engage the stakeholders in developing that,” Mollow said. “We’re looking to have it submitted at the end of September, and having it retroactive to July 1.”

Medi-Cal children now receiving ABA therapy likely will have that care retroactively paid for by Medi-Cal.

Mollow said the state also is in touch with CMS on technical clarifications of the federal guidance states recently received from CMS officials — guidance that led to implementation of autism therapy under Medi-Cal, she said.

“We plan to have a formal meeting with stakeholders on Aug. 29 regarding this policy we’re looking to implement,” Mollow said.

The new policy should start by the beginning of next year, Mollow said. Till then, there is a lot to do to develop the provider network and reimbursement rates, she said.

“And the question is what to do in the interim, when people are looking to get services now,” Mollow said.

Autism advocates were understandably delighted.

“We’re thrilled that the state is moving in this direction, and very encouraged by the steps they’re taking,” said Kristin Jacobson, president of Autism Deserves Equal Coverage, an advocacy group based in Burlingame. “We want to work with them to implement this as expeditiously as possible.”

“It’s important for families to know this is happening,” said Karen Fessel, executive director of the Autism Health Insurance Project. “I’m cautiously optimistic. I do believe this is going to happen, and it’s a question of when.”

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  • Deidra Sanchet

    ABA therapy for many adults with autism is one of the most therapeutic interventions to prevent them from regressing even further as they age. I