Medicaid Coverage for Autism, Part 2

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Let’s look further at the new Medicaid coverage for intensive intervention. The approved plan provides insight into what policy makers and Minnesota’s government (Department of Human Services) support as treatment for children with autism. As of July 1, 2015, Medicaid will pay for two kinds of Early Intensive Developmental and Behavioral Intervention (EIDBI). One is Applied Behavior Analysis (ABA) and the other is Developmental and Behavioral Intervention (DBI). Services begin with a Comprehensive Multi-Disciplinary Evaluation (CMDE) to determine medical necessity.

Authors of the coverage plan should be commended for requiring this evaluation to consider information from the child’s physician, licensed therapists and licensed teachers. Let’s hope all evaluations do. It is through this type of evaluation that everyone gains insight into contributing factors, underlying medical conditions, etc. that may be impacting a child’s ability to learn and grow.

In Minnesota only teachers are required to have a license in autism that is earned through specific coursework. We support this. Autism is such a complex disorder that anyone performing diagnosis or treatment in autism needs coursework that goes beyond typical child development and behavioral strategies. It is through training that practitioners can truly understand this disorder and help families.

The best news about the evaluation is that it cannot be performed by the same person (mental health professional) who provides the treatment. Hopefully, there will be transparency and thoughtful deliberation of treatment options. Parents need to have confidence that the evaluation is done to benefit their child, not the provider of treatment.

The approved plan describes in detail various levels of training required for the people delivering intervention. This flexibility will create good opportunities to build capacity in both rural and diverse communities. It will provide access to early intensive intervention for families who have lacked in the past such resources as good insurance coverage and knowledge of community systems.

Lastly, the plan notes that Early Intensive Developmental and Behavioral Intervention (EIDBI) is not intended to replace school services. In our state special education services are free to children who qualify because they have autism, starting at birth. However, school service is not intensive. It is understandable that parents will choose intensive intervention to address functional skills training and lack of social engagement.

The big question here is how long should this intensive intervention continue? Research on autism supports intensive intervention for a window of about two years. It will be interesting to see how agencies, providers and schools balance these needs. And especially how parents will be involved in the ongoing development of these services.

Author: Editorial Team

A select group of our board members who have something to say, but want to say it together. We also use this byline for those who wish to write anonymously.

2 Comments

  1. Are these same services covered by insurance carriers?

    • Not necessarily. Often private insurance carriers do use Medicaid/Medicare benefits are guidelines for their coverage.

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