Unfortunately, families are struggling accessing ABA treatment. The above link to the Help! I can’t access ABA through Medicaid document will provide easy steps parents can use to file a compliant or appeal with Medicaid.
Our founder, Marla Root, is a parent of a child with autism and can answer any questions you have at our contact page. Please feel free to reach out.
Update October 15, 2021
The Illinois Department of HFS has expanded the practitioner types allowed to deliver ABA treatment which now includes BCBAs without any requirement of a dual licensure. However, a board certified behavior analyst (BCBA) will need to work under a state certified Behavioral Health Clinic or a Licensed clinical psychologist or licensed clinical social worker. Unfortunately, HFS has placed the coverage for ABA treatment under a section of the Medicaid state plan that requires a licensed practitioner to supervise treatment. This is causing a barrier to accessing treatment. Advocates and providers have advocated to move the coverage under the preventative services section of the Medicaid state plan which would not require a licensed practitioner involvement similarly to what we see in commercial insurance. Parents should reach out to their managed care plan to request ABA services and if no provider can be found, file an appeal through the above document Help! I can’t access ABA through Medicaid.
New Medicaid ABA Benefit: HFS Announced the Benefit would begin November 2020, Update February 2021
During the last state budget process, the Governor signed the new state budget into law on June 5, 2019 which included funding families successfully advocated for in Medicaid for a benefit to cover applied behavior analysis (ABA) treatment for Medicaid recipients. Approximately $42 million was dedicated to the Department of Healthcare and Family Services (HFS) budget to cover the benefit.
In September 2019, HFS submitted a state plan amendment which was approved by Federal Medicaid (CMS) January 2020. However, the benefit offered a very narrow, limited practitioner type stating BCBAs would also have to be credentialed as either a licensed social worker or a doctorial level licensed clinical psychologist. This created an immediate access issue for Medicaid eligible children ages 0 to 21 all around that state.
In October 2020, HFS released further guidance on the continued efforts to get the benefit started. Our Coalition hired a Medicaid billing and credentialing specialist to help us navigate the challenges and we are very thankful for HFS’ openness to work with us and to collaborate on trainings for ABA providers.
On February 9 and 11, 2021, our Coalition and the Illinois Healthcare and Family Services (HFS) Division of Medical Programs, will be offering a new Medicaid Training Webinar on IMPACT Registration, MCO Universal Roster Credentialing for ABA Providers, and prior authorization and billing processes for HFS.
Learn more information about the timeline and prop benefit here: Blog Post
Legislation: Illinois Behavior Analyst Licensing Act
Currently, behavior analyst are not licensed by the state of Illinois. Licensure is important to ensure consumer protection through the state verifying the behavior analyst licensure and ongoing continuing education and offering a way for individuals and families to file a complaint if needed. Also, Illinois health insurers are want a system to verify credentials through a state monitoring system.
In January 2021, a new General Assembly began at the State House and practitioners and advocates will continue to strategize how to move a bill forward.
Links for more information:
Previous filed bill: HB 2710 Full Bill Language
The Illinois Association for Behavior Analysis (ILABA)
Behavior Analyst Certification Board (BACB)
The Association of Professional Behavior Analysts (APBA)
How can you help advocate?
Find your district state Senator or Representative: How do I find my legislators?
Please consider sharing the outcomes from your discussions you may have with your legislator and insurer with Marla Root at the Illinois Autism Insurance Coalition by calling 614.565.5765 or through our website.