{"id":11431,"date":"2023-11-13T12:41:00","date_gmt":"2023-11-13T12:41:00","guid":{"rendered":"https:\/\/www.freeway.com\/?p=7213"},"modified":"2023-12-11T17:05:22","modified_gmt":"2023-12-11T17:05:22","slug":"its-here-medi-cal-coverage-for-autism-treatment","status":"publish","type":"post","link":"https:\/\/www.freeway.com\/blog\/health-insurance-blog\/its-here-medi-cal-coverage-for-autism-treatment\/","title":{"rendered":"It\u2019s Here! Medi-Cal Coverage for Autism Treatment"},"content":{"rendered":"\n

Medicaid for Autism Treatment: It\u2019s Here!<\/strong><\/h2>\n\n\n\n

In January 2014, the Centers for Medicare and Medicaid Services, CMS<\/a>, said that people under 21 must get Medicaid for Autism Spectrum Disorder (ASD) treatment.<\/p>\n\n\n\n

Managed by the California Department of Health Care Services (DHCS), Medi-Cal is California\u2019s Medicaid program<\/a>, which in the same year started providing essential behavioral health treatment (BHT) for autism, including applied behavior analysis or ABA therapy for enrolled children, when the treatment is medically necessary. Healthcare insurance<\/a> traditionally didn’t cover therapy. <\/p>\n\n\n\n

Autism Spectrum Disorder (ASD) is a developmental condition that affects social interaction, speech, and repetitive behaviors. It manifests differently in each individual, making it challenging to identify a one-size-fits-all approach. Understanding these complexities is essential for tailored interventions.<\/p>\n\n\n\n

The federal Centers for Disease Control and Prevention<\/a> reports that they have diagnosed ASD in 1 in 36 children in the United States.  ASD affects people across all racial, ethnic, and socioeconomic groups, making it essential to provide comprehensive support and resources.
<\/p>\n\n\n\n

Medicaid Autism Services for Childrens and Adults<\/strong><\/h2>\n\n\n\n

One of the key strengths of the Medicaid plan is its commitment to breaking down barriers. Through Medicaid Managed Care Organizations (MCOs), individuals with autism gain access to a network of healthcare providers specializing in autism services. <\/p>\n\n\n\n

Medicaid for autism ensures understanding and support for every individual’s journey, whether it’s through diagnostic assessments, early intervention programs, or specialized medical care<\/a>.<\/p>\n\n\n\n

Medicaid for Children with Disabilities <\/strong><\/h3>\n\n\n\n

In the case of children, Medicaid for autism covers services like behavioral therapy, speech and language therapy, and occupational therapy, to improve children\u2019s behavior and help them learn new tasks by nurturing essential skills and fostering communication. <\/p>\n\n\n\n

Early intervention, supported by EPSDT<\/a> Services, paves the way for meaningful progress, ensuring that financial constraints aren\u2019t a limitation for the child’s developmental journey.<\/p>\n\n\n\n

Medicaid for Disabled Adults <\/strong><\/h3>\n\n\n\n

Medicaid for autism helps adults with autism through Home-and Community-Based Services (HCBS) waivers. Some waivers are specifically for autism, while others are for adults with disabilities. Waivers may or may not consider the criteria for IQ. You can see your state\u2019s specifications in Medicaid waivers<\/a>.<\/p>\n\n\n\n

Applying for Medicaid for Autism<\/strong><\/h2>\n\n\n\n

Medicaid eligibility criteria to access Medicaid autism services often include factors like income, household size, and disability status, however, this may vary by state.  In special cases, like when the individual requires an institutional level of care, they may exclude some factors.<\/p>\n\n\n\n

We suggest contacting your state\u2019s specific program<\/a> to get the details on what qualifies for Medicaid.<\/p>\n\n\n\n

Medi-Cal for Autism<\/strong><\/h2>\n\n\n\n

California has given its approval for this treatment in order to adhere to a decision made by the U.S. Centers for Medicare & Medicaid Services. This decision states that the therapy must be provided, if it is determined to be medically necessary, as part of a range of services for individuals aged 21 and under who come from low-income backgrounds. <\/p>\n\n\n\n

According to the Autism and Developmental Disabilities Monitoring (ADDM) Network<\/a>, the average age of first ASD diagnosis was at 36 months, or 3 years, which is lower than the national average of 4-8 years.<\/p>\n\n\n\n

Karen Pierce, PhD, Autism Center of Excellence and principal investigator of the ADDM California site, states that they diagnose some children in San Diego with autism by their second birthday and connect them to services quickly thereafter. <\/p>\n\n\n\n

Identifying the condition sooner helps the children start receiving proper support, making them more likely to thrive in life and school.<\/p>\n\n\n\n

How to get Behavioral Intervention Therapy (ABA) in California<\/strong><\/h3>\n\n\n\n

In order to be eligible, children will need to have a diagnostic assessment of autism spectrum disorder, and a prescription for ABA therapy from either a treating physician or psychologist. The prescribing professional will need to explain why ABA therapy is medically necessary for a child. <\/p>\n\n\n\n

Families on Medi-Cal can contact their health plan<\/a> and their child\u2019s primary care physician<\/a> and request an assessment for ABA therapy.<\/p>\n\n\n\n

California will work to keep costs under control by setting fixed rates for care under a managed care model. The federal government will pay for half of the cost of providing autism treatment through Medi-Cal, and the state will pay the rest.<\/p>\n\n\n\n

Consumers having difficulty with their health plan who are not sure what their rights include, can contact the Medi-Cal Ombudsman\u2019s office<\/a> for help.<\/p>\n\n\n\n

In addition to checking into Medi-Cal coverage<\/a>, don\u2019t forget to check out healthcare assistance under the state\u2019s new health insurance plans. You may be eligible for help under Obamacare<\/a>.<\/p>\n\n\n\n

You can sign up for a quality MediCal, ACA plans, and other health insurance offers through Freeway Insurance. Freeway collects insurance quotes from some of the top providers in the nation to present to you the lowest-priced insurance possible. Get a free <\/em>health insurance quote<\/em><\/a> online or call us today at <\/em>(800) 777-5620<\/em> to get quality protection, avoid the tax penalty, and save money.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

Medicaid for Autism Treatment: It\u2019s Here! In January 2014, the Centers for Medicare and Medicaid Services, CMS, said that people under 21 must get Medicaid for Autism Spectrum Disorder (ASD) treatment. Managed by the California Department of Health Care Services (DHCS), Medi-Cal is California\u2019s Medicaid program, which in the same year started providing essential behavioral […]<\/p>\n","protected":false},"author":1,"featured_media":11532,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[309,306],"tags":[13],"importance":[],"type-content":[],"acf":[],"_links":{"self":[{"href":"https:\/\/www.freeway.com\/blog\/wp-json\/wp\/v2\/posts\/11431"}],"collection":[{"href":"https:\/\/www.freeway.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.freeway.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.freeway.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.freeway.com\/blog\/wp-json\/wp\/v2\/comments?post=11431"}],"version-history":[{"count":2,"href":"https:\/\/www.freeway.com\/blog\/wp-json\/wp\/v2\/posts\/11431\/revisions"}],"predecessor-version":[{"id":26571,"href":"https:\/\/www.freeway.com\/blog\/wp-json\/wp\/v2\/posts\/11431\/revisions\/26571"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.freeway.com\/blog\/wp-json\/wp\/v2\/media\/11532"}],"wp:attachment":[{"href":"https:\/\/www.freeway.com\/blog\/wp-json\/wp\/v2\/media?parent=11431"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.freeway.com\/blog\/wp-json\/wp\/v2\/categories?post=11431"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.freeway.com\/blog\/wp-json\/wp\/v2\/tags?post=11431"},{"taxonomy":"importance","embeddable":true,"href":"https:\/\/www.freeway.com\/blog\/wp-json\/wp\/v2\/importance?post=11431"},{"taxonomy":"type-content","embeddable":true,"href":"https:\/\/www.freeway.com\/blog\/wp-json\/wp\/v2\/type-content?post=11431"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}