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. 

Watch our brief video about Patient Protections

 

Check out more videos on access challenges and what families can do next.

Advocacy Action Alerts

Keep up-to-date on our Advocacy Action Alerts.

Share Your Story With Us

Are you waiting for access to an ABA provider under your Medicaid insurance? We want to hear about your family's challenges. Please share your story with us including what city you live in. Visit our contact page or email us directly at help@ilasd.com.