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Approval of Autism Benefit in Louisiana May Influence California Budget Talks

CMS last month approved a state plan amendment in Louisiana that allows that state to pay Medicaid providers for a type of autism service — applied behavior analysis treatment, known as ABA therapy.

That agreement could pave the way for California lawmakers to follow suit for Medi-Cal (California’s Medicaid program), according to  Melissa Cortez-Roth of Governmental Advocates, a lobbying firm.

“This clearly states that CMS is approving this benefit,” Cortez-Roth said. She said ABA therapy is included as part of a Medicaid benefit for those under age 21 called Early and Periodic Screening, Diagnosis and Treatment.

“If that’s the case,” she said, “I would think they would approve it for California, too.”

California  Department of Health Care Services officials have said they’re carefully watching what happens in Louisiana and Washington state, where CMS was requested to approve state plan amendments on this issue.

“California and other states are currently awaiting guidance on ABA services from CMS, which we expect to receive soon,” said Norman Williams, deputy director of public affairs for DHCS. “This guidance is what will be used to set policy direction for the inclusion of ABA therapy as a covered Medicaid benefit.”

Policy direction could come this week because Sunday night is the deadline for finalizing the May budget revision, Cortez-Roth said.

“The other states have been forced to include it as a benefit by legal action,” she said. “We’re hoping to not do that in California.”

The legislative estimate is that including ABA therapy as a Medi-Cal benefit could cost the state about $50 million a year. Legislators have been discussing whether to include that in the budget revision.

“We’ll know by Sunday,” Cortez-Roth said. “We’re cautiously optimistic, but we’re still waiting.”

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Capitol Desk Medi-Cal