Medicaid will start paying for autism therapies

26 Jul

Medicaid will start paying for autism therapies. The news was released at the last IACC meeting and I’ve been trying to work out how best to write it since. Seems pretty straightforward, doesn’t it? Not to take anything away from the person who presented it at the meeting but after a while of hearing things like:

Those categories include: section 1905(a)(6) – services of other licensed practitioners; section 1905(a)(13)(c) – preventive services; and section 1905(a)(10)- therapy services.

I just get saturated with the 1915(a) vs 1915(i) type language.

Here’s the announcement: Clarification of Medicaid Coverage of Services to Children with Autism

Here’s one of the first paragraphs:

The federal Medicaid program may reimburse for services to address ASD through a variety of authorities. Services can be reimbursed through section 1905(a) of the Social Security Act (the Act), section 1915(i) state plan Home and Community-Based Services, section 1915(c) Home and Community-Based Services (HCBS) waiver programs and section 1115 research and demonstration programs.

See what I mean? Take from this “the federal Medicaid program may remburse for services to address ASD”

How did this come to pass? A lot of people have been pressuring medicaid for some time to provide autism services. This includes lawsuits, like this one in Florida (Judge: Florida Medicaid Must Cover Therapy for Autism).

If you listen in or watch the IACC meetings, you know that for the past few years one of the sources of pressure on Medicaid has been from IACC member Idil Abdul. I don’t know if a meeting has gone by where Idil hasn’t talked about the inequities of a system where we say we will give medical support to our disabled poor, but we withhold support for treatments related to their disability. Or, to put it simply: why should kids with private insurance get speech, OT and other services while other kids don’t under medicaid?

People often ask what is the value of the IACC and here is one of those unquantifiable benefits. Idil did what a public representative to a federal committee should do: she informed federal members of the needs of the community. Across the table from her was John O’Brien of Medicare and Medicaid Services. John is a good guy and would often patiently correct some factual errors in what Idil had said. But he had to listen to Idil.

And for those of us who know Idil, when I say “she informed federal members” you have to know that “informed” is a major understatement.

Would this shift in Medicaid policy have happened without Idil? It was a big group effort as I’ve already said. Would it have happened later without Idil? We can’t rerun the experiment.

Just to be clear–this wasn’t an effort of the IACC. This was an effort of a member of the IACC. Made possible by her being on the IACC. It’s an odd distinction, but an important one. The structure congress created of the IACC got Idil’s voice in the right place at the right time.

While on the subject of distinctions: as always, my comments are my own and they do not represent the views of the IACC.


By Matt Carey

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4 Responses to “Medicaid will start paying for autism therapies”

  1. lilady July 26, 2014 at 05:26 #

    Hooray for Idil Abdul and her persistence on behalf of autistic youngsters who depend on Medicaid for their health care coverage.

    I’m also impressed with John O’Brien who tutored Idil about the intricacies of the Medicaid funding stream. There really are good and decent bureaucrats who go above and beyond for the sake of the families and the children they serve.

    • Sullivan (Matt Carey) July 26, 2014 at 05:57 #

      I didn’t give enough credit above to others. I think that the letter sent to the Secretary of HHS
      http://iacc.hhs.gov/publications/2013/letter_coverage_032513.shtml

      includes a statement about medicare. A lot of people have an interest in improving this, Idil just stands out. A lot. (there was a great moment when Idil made a statement and the person on the phone said something like, “I assume that was Idil”. She was a known person).

      Another big champion out there is David Mandel.

      • BA July 27, 2014 at 20:13 #

        No doubt they are both very strong advocates (and I know Dr. Mandel has been a tireless advocate for effective services for pediatric mental health care for a long time) but yes this would have happened eventually because of a number of reasons. First and what I saw as the most likely route was that there would be a domino-effect as state after state had decisions like the one in FL. FL is not the only state with a positive decision on this matter. Second, Autism Speaks (I know, not the most popular of groups among the science-based medicine crowd but the government relations division is full of hard working and effective advocates for access to services) has had autism insurance reform rolling across the country. This would have eventually happened but there are many thanks to throw around and no shortage of good people to throw them to. So thank you all.

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