Medicaid Coverage for Autism


It’s good news that beginning July 1, 2015 medical assistance will pay for intensive intervention for children with autism. This approval, granted by the Centers for Medicare and Medicaid Services, was noted in a recent Star Tribune article describing the persistent advocacy of a Somali woman, Idil Abdull. Her tireless advocacy on behalf of poor and disabled individuals who receive Medicaid is a stunning example of what a determined parent can accomplish.

Let’s take a look at the plan drafted by the State of Minnesota for those who qualify for medical assistance. It will provide Early Intensive Developmental and Behavioral Intervention (EIDBI), defined as intervention that will address both the acquisition of functional skills and the core deficits of autism spectrum disorder. Under the plan there are two kinds of interventions approved. One is Applied Behavior Analysis (ABA), which is a structured program of strategies to build targeted functional skills for daily living. The other is Developmental and Behavioral Intervention (DBI) that addresses core deficits of autism like social engagement. It appears that families must choose the intervention. The big questions will be: Are there available community providers? What will help the child the most? How will a person decide?

The plan also states that Early Intensive Developmental and Behavioral Intervention will provide services to educate and support families, reduce stress, and improve long-term outcomes. Educating families/caregivers is later defined as training on the child’s development status and techniques and strategies to promote the child’s development. The focus is on the medically necessary treatment of the child.  There is no clear description of educating families.

In time, hopefully, there will be recognition of the promising research of the Mind Institute on the Early Start Denver Model which integrates developmental relationship-focused strategies with the teaching practices of applied behavior analysis. In 2014, MIND research demonstrated promising outcomes with training parents to deliver the intervention. This approach would fit with the plan, approving services provided on behalf of the child to the parents. It also acknowledges that parents are the people most committed to the long-term outcomes of the child with ASD. Education and support for families creates a foundation that lasts far beyond intensive intervention. 

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.

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