But others sharply disagreed. “This makes clear that a state has no discretion to avoid providing to any child autism-related services, including (applied behavior analysis therapy), which are medically necessary,” said Sheldon Toubman, a staff attorney and Medicaid specialist at the New Haven (Conn.) Legal Assistance Association.
State Medicaid agencies in Delaware, Illinois, Nebraska, Utah and Wisconsin said they are still trying to understand the bulletin and its financial impact. Some states and insurers expressed alarm about the costs involved, while others noted they already were covering some treatment. There are no official estimates of the cost of the CMS coverage policy. But some say it could boost costs by hundreds of millions of dollars a year.
The CMS did not respond to requests for comment by deadline.
In a little-noticed move on July 7, the CMS posted an information bulletin about coverage for autism services under the Medicaid law's provision for early and periodic screening, and diagnostic and treatment services. “In response to increased interest and activity with respect to services available to children with autism spectrum disorder (ASD), CMS is providing information on approaches available under the federal Medicaid program for providing services to eligible individuals with ASD,” the agency wrote. In the document, the CMS said it was interpreting current Medicaid regulations.
Following the announcement, patient advocates said thousands of children in low-income families who currently are not receiving any treatment could begin to get it. State Medicaid and CHIP programs have had widely varying coverage policies for comprehensive autism services. For example, Oklahoma hasn't covered applied-behavior analysis therapy at all and has no plans to, while Oregon will begin offering it Jan. 1, but only for children up to age 12.
Oklahoma officials questioned whether applied-behavior analysis therapy specifically was being mandated. ABA treatment involves behavioral specialists leading autism patients through drills to help with speaking and social skills. The annual cost of the therapy ranges from $25,000 to $70,000.
Officials in the District of Columbia, Florida, Idaho, Maine, New Jersey, Ohio, Washington and West Virginia said they are already covering the services discussed in the CMS bulletin.
The Centers for Disease Control and Prevention reported this year that autism rates in children have increased from 1 in 88 children in 2012 to 1 in 68 children in 2014. More than a third of children with autism are covered by Medicaid or CHIP, according to the Association of Maternal and Child Health Programs.
