Dive Brief:
- Under a new CMS rules announced in July, all state Medicaid and Children's Health Insurance Program plans are required to offer comprehensive autism services to children.
- Previously, some states provided limited coverage certain age groups, or only up to a specific dollar amount, but under the new rules full coverage is mandatory for everyone under 21.
- CMS rules now require the state Medicaid programs to cover a full range of autism services under the "early and periodic screening, diagnostic and treatment services" provision of the law, which covers any services that are medically necessary to correct or ameliorate physical or behavioral conditions in children up to age 21.
Dive Insight:
CMS's decision in this regard must be seen as a great victory for advocates of autism treatment, which is generally far too expensive for most families to cover out-of-pocket. However, the new rules are worrying for the states, whose Medicaid leaders worried that they will require their programs write something of a blank check to meet CMS' demands.
States are worried not only because they are being required to cover more services for autistic children, but also because there is a large increase in eligible children: The new coverage guidelines apply to children with autism spectrum disorder, a diverse group of developmental conditions including autistic disorder and Asperger syndrome, which affects roughly 1 in 68 children according to the CDC.
Nonetheless, advocates say, even expensive services costing as much as $50,000 per year can save money over time, with almost half of children who get early interventions (such as applied behavioral analysis) achieving mainstream status.