Most Illinois Families with Medicaid Insurance are waiting to Access ABA Services for their children with autism.
What specifically is stopping families from getting access to ABA today?
Currently, most ABA providers cannot find the licensed professionals Medicaid requires to supervise the behavior analyst (BCBA) they employ. This is leaving families on very long wait lists with most families not finding any approved Medicaid ABA providers in their communities. The behavior analyst is the most common practitioner type that oversees ABA therapy and within commercial employer-based insurance, there is no requirement for them to be supervised. Unfortunately, there is a workforce shortage in all human services industries, and it is very difficult to find the required licensed professionals.
Why are children enrolled in the state’s Medicaid Health plan having such difficulties accessing ABA therapy when ordered or prescribed by their physician or psychologist?
Medicaid coverage for applied behavior analysis (ABA) therapy for the treatment of autism spectrum disorder (ASD) is still not accessible to most children throughout Illinois who have the state's Medicaid health plan. The Department of Healthcare and Family Services (DHFS) initiated coverage for ABA therapy in October 2020, however, the coverage has not been accessible due to practitioner supervision requirements that led to only a very few providers being able to deliver ABA therapy services in the entire state.
Current Approved HFS/Medicaid Delivery Options for ABA
Option 1: October 2020, Licensed, Dual Professionals only. Includes social workers and psychologists who are also certified behavior analysts (BCBA).
Option 2: April 2022, Added Behavior Analysts (BCBA) with a requirement they are supervised by a licensed professional. Also added ABA could now be delivered by a state-approved Behavior Health Clinic (BHC).
The Problem: Medicaid providers are mainly attempting to deliver ABA currently under option two above but with the workforce shortages in health care, providers cannot find generally licensed professionals to supervise the behavior analysts.
Future HFS/Medicaid Delivery Options for ABA
Option 3: On a future date, a behavior analyst will be allowed by Medicaid to deliver ABA without the supervision of a licensed professional.
In January 2023, HFS proposed new rules for Adaptive Behavior Services which is the umbrella service that includes two treatment services: ABA therapy and Developmental Therapy. In this link to the Register, please see pages 337 to 343.
The Problem: There are restrictive treatment limitations based on age and severity that will impact many looking to access services and overburdensome certification requirements for center-based service delivery options which will impact families greatly who want out-of-home ABA services. Read the Coalition's comments on these proposed rules below.
Action Alerts Will Be Coming Soon.
We will soon be posting advocacy action alerts on opportunities for your family to advocate for change. We encourage families to file appeals with their managed care plans if you are not getting access to ABA services. Learn more about our sample appeal templates that are easy for you to use to advocate for the care your child needs.
Advocacy Action Alerts as of September 1, 2023 - Medicaid Coverage of ABA Therapy will be opening up this Fall!
Advocates passed state legislation that will now require Illinois Medicaid (HFS) to allow Behavior Analysts (BCBA or Board Certified Behavior Analysts) to practice ABA therapy without a licensed supervisor to oversee their work. This supervision requirement was the biggest barrier families faced when trying to access ABA because there were not enough supervisors to meet the demand. Our Coalition is working to support ABA providers to enroll in the Medicaid system and we hope families will be able to access ABA services by early to mid November 2023. Please reach out to us on our contact page if you have any questions.
One-Pager Access Alert for Families, Providers & Stakeholders
Our Coalition is thankful for our partners in developing informational materials for families. Thank you to the Illinois Council for Developmental Disabilities and the Illinois Autism Taskforce.
Watch our brief video on what is causing the access challenges.
See other videos about patient protections and how to advocate for care.
View Our Public Comments on DHFS/Medicaid Proposed Rules for Future Delivery Options
In February 2023, the Coalition provided public comments on the access challenges within Medicaid's Proposed Rule for ABA.