Medicaid-eligible Children, Adolescents and Young Adults with Autism have Patient Protections
EPSDT offers Patient Protection
The EPSDT federal mandate covers early, periodic, screening, diagnosis, and treatment services and requires the state Medicaid agency to cover and ensure children receive the medically necessary care prescribed by a physician or recommended by a psychologist within a reasonable amount of time.
EPSDT’s goal is to assure that individual children get the health care they need when they need it – the right care to the right child at the right time in the right setting. It goes on to state children’s health problems should be addressed before they become advanced and treatment is more difficult and costly.
EPSDT provides patient protections from birth through 21 years of age.
Federal & State Mental Health Parity Laws offer Patient Protections
The Federal parity law is called MHPAEA (Ma-Pe-Ah). It stands for the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.
In general, ‘parity’ under MHPAEA requires health insurance plans to treat patients seeking mental health and addiction services the same as patients seeking medical and surgical services. In the past, ABA therapy had age and hours restrictions and many families were forced to go out of network to find providers which drove up their out-of-pocket cost. MHPAEA stopped these inequities.
Today, most consumers of all ages seeking ABA therapy for the treatment of Autism Spectrum Disorders have MHPAEA protections.
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 they are not getting access to ABA services. Learn more about our simple appeal templates families can use to advocate for care.
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.
Watch our brief video about Patient Protections
Check out more videos on access challenges and what families can do next.