A judge in Florida has ruled that Florida’s Medicaid insurance program must cover the cost of applied behavioral analysis therapy for children who have an autism spectrum disorder. This ruling could, potentially, lead the way for other states to include coverage for ABA in their Medicaid programs.
Applied behavioral analysis is also called ABA. It is a psychological form of treatment that is very necessary for children who have an autism spectrum disorder (ASD). This form of therapy is designed to improve the child’s behavior, language, and cognitive development. Kids who receive ABA therapy will improve in their ability to communicate with others, and in their ability to interact with peers.
ABA therapy tends to be rather expensive, which is why many insurance companies, across the United States, have fought hard to be allowed to exclude coverage for ABA in a typical health insurance policy. Fortunately, several states have made laws that require private health insurance companies to cover ABA.
This is an ongoing type of therapy that can take several years of treatment. Parents who do not have the type of health insurance that will cover ABA therapy, or who have insurance that will not cover the entire cost of it, have to pay for it out of pocket. A recent study shows that this is one of the reasons why families who are caring for a child that has autism have less income than families that do not have children with an ASD.
In Florida, there is a law that requires private health insurance companies to cover the cost of applied behavioral analysis therapy for children who have autism. The problem is that this law only includes private health insurance plans. Children who are covered by a public health insurance plan, like Medicaid, were not getting insurance coverage for ABA therapy.
Medicaid is a public form of health insurance. It is for low-income families and individuals. The law in Florida that required only private, but not public, health insurance plans to cover ABA excluded children from poor families from that protection. The law helped more affluent families to afford ABA treatment for their children who had an ASD, but denied the same assistance for the families who truly could not afford to pay for ABA out of their own pockets.
U.S. District Judge Joan Lenard signed an order that now requires Florida’s Medicaid insurance program to begin paying for applied behavioral analysis therapy. In the order, the judge wrote:
“It is imperative that autistic children in Florida receive [behavioral therapy] immediately to prevent irreversible harm to these children’s health and development”.
This ruling is significant not only for the families who live in Florida, but for families in other states. There is now a legal precedent set where a judge ruled that Medicaid had to cover the cost of ABA therapy. Lawyers in other states could use this when they argue why other state’s Medicaid programs should also cover ABA therapy.
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