Medicaid Coverage: Feds Clarify Obligations To Kids With Autism

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Melanie Feazell works with Declan Byrne during an ABA session. Federal officials say states must provide treatment services like ABA for kids with autism on Medicaid. (Francine Orr/Los Angeles Times/MCT)


Medicaid programs nationwide must offer medically necessary diagnostic and treatment services to kids with autism, the Centers for Medicare and Medicaid Services told states in a bulletin earlier this month. (From Disability Scoop, July 17, 2014). That includes everything from speech and occupational therapy to personal care services and medical equipment, the agency said.”

Clarification of Medicaid Coverage of Services to Children with Autism, Informational Bulletin (July 7, 2014)  from the Department of Health and Human Services, Centers for Medicare & Medicaid Services, (CMS).

“The services must be included in what’s known as the Early and Periodic Screening, Diagnosis and Treatment program, or EPSDT, a package of offerings that every state is required to provide children under age 21 who qualify for Medicaid.

The move comes in response to an increasing number of inquiries in recent years from states facing legal action for denying services to Medicaid beneficiaries with autism, Melissa Harris, director of the Division of Benefits and Coverage at CMS, told members of the Interagency Autism Coordinating Committee recently.

Many of the court cases focused on coverage of ABA therapy, though Harris said that CMS was careful not to single out ABA or any other specific treatment in its directive to states.”

Full article published July 17, 2014 at Disability Scoop

EPSDT Benefit – Early and Periodic Screening, Diagnosis and Treatment

Michelle Andrews (NPR, August 26, 2014) explained, “The EPSDT benefit, as it’s called, covers any services that are medically necessary to correct or ameliorate physical or behavioral conditions in children and young people up to age 21.”

In Federal Officials Order Medicaid To Cover Autism Services  she reported that:

“…comprehensive autism services must be covered for children under all state Medicaid and Children’s Health Insurance Program plans, another federal-state partnership that provides health coverage to lower-income children.”

“The new coverage guidelines apply to children with autism spectrum disorder, a group of developmental conditions including autistic disorder and Asperger’s syndrome.”

“Although coverage of applied behavioral analysis, which uses positive reinforcement and other techniques to encourage behavior change, isn’t explicitly required, advocates expect it will be covered.”

“But the new policy is important because it requires mandatory coverage for everybody under 21, says Kristin Jacobson, co-founder and president of Autism Deserves Equal Coverage, a Burlingame, Calif.-based advocacy group.”

EPSDT from DHHS, Maternal and Child Health


  1. Your article discussing Medicaid coverage and the federal clarification of obligations to children with autism provides important information for families navigating the healthcare system. By shedding light on the Medicaid guidelines and requirements, you help families understand their rights and the available supports for children with autism. This clarification by the federal government reinforces the importance of ensuring access to necessary healthcare services for individuals with autism. Thank you for sharing this valuable resource that can empower families and advocate for the well-being of children with autism. Well done on providing important information to support families in accessing the healthcare services they need

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