Medicaid: States Cannot ‘Delay Or Deny’ Autism Treatment

WASHINGTON, DC (September 29, 2014) The federal government has issued guidance to states emphasizing that they can neither delay nor deny medically necessary autism treatments, such as ABA, through their Medicaid programs for individuals up to age 21. The message was delivered in FAQs posted September 24 regarding the July 7 Informational Bulletin issued by the federal Centers for Medicare & Medicaid Services (CMS) concerning autism benefits states must provide through the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program. While no specific deadline is set forth in the FAQs, CMS believes states should complete this work expeditiously and should not delay or deny provision of medically necessary services. In addition to questions on timing, there was confusion among some states because the July Bulletin did not explicitly state that ABA, the most well-accepted and efficacious therapy for individuals with autism, was a required treatment.  In the FAQ’s, CMS made
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