Is it Possible to Receive Medicaid for Autism?

medicaid for autism

Currently, approximately one percent of the population falls on the spectrum of autism disorders. Autism is a developmental disability that can cause impairments in areas like communication and behavior.  This might not seem like a lot but there are many people in each city that are in need of some sort of assistance because of their autism-related issues. This could be monetary assistance, therapy, education, resources, etc. Recently, our federal government made the decision to provide medical care and assistance through a number of Medicaid programs. Depending on the state, there are different resources available. Autism services are provided under the Early and Periodic Screening, Diagnostic and Treatment benefit.  These services are provided to children that have been diagnosed with autism spectrum disorders from birth up to the age of twenty-one.  Diagnostic services are available as well as ongoing treatment.

The criteria for an adult or child’s diagnosis of autism is defined by the Diagnostic and Statistical Manual of Mental Disorders.  A diagnosis of autism spectrum disorder now includes other conditions that were previously diagnosed separately including Asperger syndrome and pervasive developmental disorder.

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What Exactly Is Covered by Medicaid for Autistic Adults and Children?

What Is Covered by Medicaid for Autistic Adults and Children?

Can you get government assistance for autism?  The answer is yes.  Currently, Congress has decided what benefits are going to be provided to patients with autism spectrum disorder by way of Medicaid assistance. The federal government does not provide very specific details on this coverage though. Basically, each state determines what type of autism services are medically necessary and then that will be covered. For the most part, this is an umbrella term and anything pertaining to autism will be included.  Examples of covered services may include:

  • behavioral health treatment by board certified behavioral analysts
  • pharmacy care
  • psychiatric care
  • psychological care
  • therapeutic care

Does a child with autism qualify for Medicaid automatically?  The answer is no.  Many children and adults will qualify for Medicaid with autism, but not all.  Typically, qualifications are income based.  If the child or family is not Medicaid eligible, they may need to find the best health insurance for autism through the federal government marketplace or a private insurance plan.

Autism Speaks is a nationwide organization that aims to educate families, patients and the public on autism spectrum disorders. Their organization has dedicated much of their time to monitoring all states in the U.S. and ensuring that nothing is being ignored. Medical professionals also have a say in what types of assistance their patients will be eligible to receive based on their diagnosis and their current state of health. For more information, you can visit Autism Speaks.

Why Was There a Delay in Coverage?

The decision to provide autism assistance by way of Medicaid coverage was made in 2014.  It took until February of 2022 for all 50 states to implement their Medicaid autism services benefit.  This was a huge undertaking.  Existing Medicaid plans underwent a thorough review to make sure they met these new criteria. Policy changes took place in order to get all of this coverage ready.

How Does This Affect the Medicaid Budget?

How Does This Affect the Medicaid Budget?

As with many aspects of a state’s budget, autism coverage has often been overestimated. While a state might predict they need to set aside $10 million each year for autism patients, the expenses may only add up to $3 million each year. While this does affect a Medicaid budget to some degree, it will not be quite as devastating to a budget as many politicians assume it will be. Currently, the overall cost is shared by the federal government as well as each state.

Medicaid is the main source of health coverage for approximately one-third of all American children that have been diagnosed with autism spectrum disorder. Even people with autism who have their own primary health insurance are using Medicaid coverage to access other services that can help them. Luckily, the need for Medicaid assistance for people with autism has been recognized and the changes are being put into effect to help people. If you are interested in finding out more about qualifying for coverage, you can contact your state’s Medicaid health agency.

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