Health services Medicaid must cover are called “Mandatory Benefits”. Under Washington State’s Medicaid state plan, Apple Health, services to address Autism Spectrum Disorders (ASD) and other Developmental Disabilities (DD) may be covered under several different mandatory benefit categories which include Early and Periodic Screening, Diagnostic and Treatment services (EPSDT). EPSDT benefit provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid.
When Medically Necessary ABA is prescribed for a Medicaid eligible child, the ABA has to be provided in a timely manner.
Medicaid eligible children often wait years before accessing medically necessary Applied Behavior Analysis (ABA). Children most likely left behind are older, have challenging behaviors, live in rural areas, from non-English-speaking families.
We researched reimbursement rates for these providers in comparison to other states and found that Medicaid rates are so low that there are very few slots available to medicaid eligible children at each provider.
Medicaid BCBA treatment rates by state
Medically necessary services have to be provided with "reasonable promptness". What is reasonable depends on the nature of the service and the needs of the individual child. However, outer limit of 6 months. If your child has been prescribed medically necessary ABA you can:
- Ask your Managed Care Organization for assistance with arranging for ABA, ask for case management, call providers, take tours
- If no providers available in a timely manner, you can ask your managed care organization for a single case agreement to a provider outside of their network
- Keep a call log
- Report back to the provider who prescribed ABA if you've been waiting to access ABA for 4 months or longer
- Contact members of the Children’s Mental Health Work group and the speaker of the House
- Representative Vandana Slatter: vandana.slatter@leg.wa.gov
- Senator Manka Dhingra: Manka.Dhingra@leg.wa.gov
- Speaker of the House Laurie Jinkins: laurie.jinkins@leg.wa.go
- Laurie Lippold : Laurie.Lippold@gmail.com
Ask them why your child is not accessing medically necessary ABA in a timely manner and how they can help ensure Washington State is in compliance with EPSDT.
Thank you for your consideration and for standing with us for change!