The Medicaid program covers services to treat Autism Spectrum Disorder (ASD), which affects an estimated 1 in 68 children, according to the Centers for Disease Control and Prevention. ASD is a developmental disability that can cause significant social, communication and behavioral challenges. A diagnosis of ASD now includes several conditions that used to be diagnosed separately: autistic disorder, pervasive developmental disorder not otherwise specified, and Asperger syndrome. In July 2014, CMS clarified that states are required to provide services to treat ASD (PDF, 143.2 KB) (PDF 143.2 KB) for Medicaid eligible children under the age of 21 through the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit.
States have been actively working to furnish these services under their Medicaid state plans. Several states, including Louisiana and Washington, have taken steps to license practitioners, such as behavior analysts or lead behavior analysis therapists, in order to provide services to treat ASD. Other states have been working to include, in their state plans, specific services to treat ASD, such as intensive behavioral services, skills-building training and positive behavior support services. Medicaid continues to work with states to assure that eligible children receive these important services.
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