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Signs Point to Adding Autism Coverage for Kids Under Medi-Cal Managed Care

The state has been considering the addition of autism therapy as a Medi-Cal benefit based on legal developments in other states, according to state officials at a budget subcommittee hearing this week.

“We believe it’s reasonable for the Legislature to consider adding ABA therapy services to Medi-Cal managed care [and making that] a high priority,” said Ross Brown, a fiscal and policy analyst for the Legislative Analyst’s Office.

Autism treatment known as applied behavior analysis, or ABA therapy, is required under state law to be covered by commercial health care plans — but it is still not provided as a Medi-Cal benefit. Ross said adding ABA coverage to Medi-Cal would make it consistent with commercial coverage.

There’s another big reason to consider it, he said. “There appears to be some legal uncertainty about whether ABA therapy is included in Medicaid law,” Ross said.

The legal issue is coming to a head in Washington state and is being tracked by California health officials, according to Mari Cantwell, chief deputy director at the Department of Health Care Services. 

“We are following very closely what’s happening in Washington state,” Cantwell said. “There is a state plan amendment there that was developed as a result of settlement of a lawsuit on this issue. That [plan] describes ABA services as preventive services, so should CMS approve the Washington state plan as currently drafted, it is certainly possible that these types of services would be considered EPSDT services.”

EPSDT stands for the Early Periodic Screening, Diagnosis and Treatment. If autism therapy is included in the federal guidelines for EPSDT services, California advocates believe it should lead to ABA therapy becoming a Medi-Cal benefit.

According to Elizabeth Landsberg, director of legislative advocacy for the Western Center on Law and Poverty, that’s where it belongs.

“As a legal matter, and we’re a legal organization, we believe ABA therapy coverage is required under EPSDT and the Medicaid program,” Landsberg said. “It’s frankly disgraceful that our low-income children are the only people who don’t have access to these services.”

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