CA to Broaden Kids' Medicaid Autism Coverage

California is among the first states to respond to a recent rule by the U.S. Centers for Medicare & Medicaid Services that requires the therapy to be covered, when deemed medically necessary, as part of a “comprehensive array of preventive, diagnostic and treatment services” for low-income people 21 and under. (Medi-Cal is California’s version of Medicaid.)

This type of treatment includes the sometimes costly “applied behavioral analysis,” which uses intensive drills and rewards to teach kids how to communicate and interact socially.

In California, a huge percentage of the population that stands to benefit is Latino. About a third of beneficiaries speak Spanish as their primary language, yet historically their communities have been underserved because of a shortage of Spanish-speaking providers and meager outreach and education efforts.

Taking the lead

California, however, is ahead of many states: It already has programs in place that cover a portion of autistic kids through public school districts and the California Department of Developmental Services. Although several states, including Louisiana and Washington, have taken early steps to make behavioral therapy for autism, others offer little or no public coverage for it.

California will seek to contain costs by setting fixed rates for care, under a managed care model, officials said. Even so, some observers remain concerned that the influx of thousands of kids newly eligible for autism treatment could overwhelm an already-strapped system.

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