In March of 2012, a judge ordered the state of Florida to cover the cost of autism treatment for children who were covered by Medicaid. Private insurers had previously been required to cover it. Now, the state of Florida is appealing that decision. The state wants to decide if ABA treatment is necessary on a case by case basis.
In order to fully understand this situation, you need a little background information. Applied Behavioral Analysis, (also called ABA), is a psychological form of treatment that is necessary for children who have an autism spectrum disorder (ASD). It is a therapy that is designed to improve the child’s behavior, language, and cognitive development.
Kids who have autism and who receive ABA therapy can become more able to communicate with their family and peers. The therapy is ongoing, and can become expensive for families who do not have insurance that covers it. It is important that children start ABA therapy at a very young age.
Previous to March of 2012, the state of Florida had a law that required private health insurance companies to cover the cost of ABA therapy for children who had autism. Unfortunately, the law didn’t actually require Medicaid to cover ABA therapy. The result was that the state of Florida was choosing not to cover ABA therapy for children from low-income families who were covered by Medicaid.
U. S. District Judge Joan Lenard signed an order that required Florida’s Medicaid insurance program to begin paying for ABA therapy. She said:
It is imperative that autistic children in Florida receive [behavioral therapy] immediately to prevent irreversible harm to these children’s health and development.
Now, the state of Florida is appealing the judge’s ruling. The state Agency for Health Care Administration has argued that the ruling strips the state of its ability to weigh requests for the therapy on case by case basis to ensure the treatments are “medically necessary”. The agency filed a brief that said:
There is no evidentiary support for the district court’s conclusion that [behavior analysis] services are medically necessary for all autistic Medicaid recipients under 21. In fact, the evidence established that ABA treatment is not medically necessary, or even effective, in all cases. Some children do not respond to ABA treatment at all, and, in all other cases, the efficacy of ABA treatment diminishes rapidly after an early age.
In short, the Agency for Health Care Administration in Florida is trying very hard to avoid having to cover the cost of ABA therapy for children who have an autism spectrum disorder and who are covered by Medicaid. This, in a state where private health insurance companies have been required to cover the treatment and have complied with the law.
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