[Note: Shared for #AutisticHistory archive purposes. This is NOT An Autistic Ally.]
Medicaid: States Cannot ‘Delay Or Deny’ Autism Treatment
September 29, 2014
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 clear that while it did not single out ABA as a mandated treatment, just as it does not mandate other specific treatments, like chemotherapy for children with cancer, all care that is medically necessary for an individual must be provided,” said Dan Unumb, executive director of the Autism Speaks Legal Resource Center.
According to the FAQs, this obligation to provide all medically necessary services that can be covered under Medicaid is part of the states’ “long-standing EPSDT obligations” to children from birth to 21. Additional information about the states’ EPSDT obligations is available
In the case of autism, medically necessary care includes ABA, which CMS has already indicated is a coverable service observed Unumb. “As indicated in professional literature and as held by numerous court cases, there is no question that ABA is medically necessary for many children with autism and therefore it must be made available based on individual determinations of medical necessity,” he said.
Some states have also raised concerns over the cost of providing Medicaid coverage of ABA. “This is not a new issue,” said Unumb. “In almost all of the three dozen states that have mandated coverage for private insurance, nearly every state initially over-estimated the cost of providing ABA, sometimes by more than 1,000 percent.”
Unumb also said it is important to keep in mind the cost-savings of providing ABA. “Studies have shown that providing treatment to children ultimately saves the states taxpayer money by reducing the need for special education and other services and lowering long-term care costs when children reach adulthood.”
The FAQs further spell out that while Medicaid State Plan Amendments are not a prerequisite to implement additional mandatory EPSDT coverage, they are strongly encouraged as a means to include the menu of services for ASD treatment as part of the State Plan’s comprehensive written statement of services. The FAQs also discuss the relationship between EPSDT services and waiver services and the transition of medically necessary services from limited waiver coverage to broad state plan coverage for EPSDT-eligible individuals.
The Autism Community Is Not The Autistic Community
Autistic people have fought the inclusion of ABA in therapy for us since before Autism Speaks, and other non-Autistic-led autism organizations, started lobbying legislation to get it covered by insurances and Medicaid.
ABA is a myth originally sold to parents that it would keep their Autistic child out of an institution. Today, parents are told that with early intervention therapy their child will either be less Autistic or no longer Autistic by elementary school, and can be mainstreamed in typical education classes. ABA is very expensive to pay out of pocket. Essentially, Autism Speaks has justified the big price tag up front will offset the overall burden on resources for an Autistic’s lifetime. The recommendation for this therapy is 40 hours a week for children and toddlers.
The original study that showed the success rate of ABA to be at 50% has never been replicated. In fact, the study of ABA by United States Department of Defense was denounced as a failure. Not just once, but multiple times. Simply stated: ABA doesn’t work. In study after repeated study: ABA (conversion therapy) doesn’t work.
What more recent studies do show: Autistics who experienced ABA therapy are at high risk to develop PTSD and other lifelong trauma-related conditions. Historically, the autism organizations promoting ABA as a cure or solution have silenced Autistic advocates’ opposition. ABA is also known as gay conversion therapy.
The ‘cure’ for Autistics not born yet is the prevention of birth.
The ‘cure’ is a choice to terminate a pregnancy based on ‘autism risk.’ The cure is abortion. This is the same ‘cure’ society has for Down Syndrome.
This is eugenics 2021. Instead of killing Autistics and disabled children in gas chambers or ‘mercy killings’ like in Aktion T4, it’ll happen at the doctor’s office, quietly, one Autistic baby at a time. Different approaches yes, but still eugenics and the extinction of an entire minority group of people.
Fact: You can’t cure Autistics from being Autistic.
Fact: You can’t recover an Autistic from being Autistic.
Fact: You can groom an Autistic to mask and hide their traits. Somewhat. … however, this comes at the expense of the Autistic child, promotes Autistic Burnout (this should not be confused with typical burnout, Autistic Burnout can kill Autistics), and places the Autistic child at high risk for PTSD and other lifelong trauma-related conditions.
[Note: Autism is NOT a disease, but a neurodevelopmental difference and disability.]
Fact: Vaccines Do Not Cause Autism.