The Feb. 13 news article “New mandate for autism care lifts financial strain” discussed a new law requiring some private insurance policies to cover autism-related services as early as July. We are concerned that the article might have given readers the incorrect impression that children enrolled in Medicaid do not have coverage for autism-related services.
Since July 2014, the federal Centers for Medicare and Medicaid Services has required states to cover autism-related services for Medicaid-eligible children up to age 21, when medically necessary. To date, few of North Carolina’s eligible of children have received these services. It is time for that to change.
States are required to provide treatment for kids with Autism Spectrum Disorder through Medicaid’s Early and Periodic Screening, Diagnosis and Treatment benefit.
ASD includes such conditions as autistic disorder, pervasive developmental disorder not otherwise specified and Asperger’s Syndrome. EPSDT services include care that is medically necessary to improve or maintain children’s health in the best condition possible, compensate for health problems, prevent them from worsening or avoid the development of additional health issues.
Early detection and preventive care for young children with ASD will not only maximize each child’s developmental potential but also save the state money in the long run by preventing more costly interventions as the child grows.
When CMS required states to provide these services, it noted they should “work expeditiously and should not delay or deny provision of medically necessary services.”
At least 24 states already offer services to children with ASD. At least five states have been sued for failing to provide these federally mandated services.
North Carolina is gradually making ASD services available to Medicaid-covered children, but it has been slow going despite the great need. The state’s Medicaid program must ensure adequate access to timely care and an adequate network of providers. It will be crucial to this effort for North Carolina to set reimbursement rates for ASD services that will attract well-trained, high-quality providers.
Parents should talk with their child’s health care providers to decide whether autism-related services may be medically necessary for their child.
Requests for services for children up to age 3 should go to the N.C. Division of Medical Assistance. For children aged 3 to 21, requests are made to the state’s contractor for behavioral health services.
Disability Rights NC urges the state to provide these critically needed services so that children get the early intervention they need to maximize their potential.
Executive director, Disability Rights North Carolina
The length limit was waived to permit a fuller response to the issue.