Expanded ABA Coverage Announced for Families with Medicaid

July 16, 2014

On Monday, July 7, the Center for Medicare and Medicaid Services (CMS) provided advisement to state agencies about covering 19205681 familymedically necessary treatments for autism for children and young adults, including behavioral health treatments such as Applied Behavior Analysis (ABA). The advisement detailed why the treatment should be covered and specified how states can implement the necessary changes.

This is a significant change in federal interpretation of currently existing regulations that govern services allowable under Medicaid programs. Through this decision CMS is also acknowledging what insurance companies, states, and other federal agencies have all echoed in recent years: provision of services, including ABA, are medically necessary.

Medicaid is a joint state/federal program whose covered benefits – and funding levels – can vary from state to state, and we expect that individual state formalization of coverage will unfold over the coming weeks to months. As a practitioner in the research and implementation of ABA services, we know how important this ruling is, and we are excited to begin working with state agencies across the country to understand how quickly they plan to open this coverage to families.

Trumpet Behavioral Health currently provides ABA services through several Medicaid Waiver programs in Colorado. Later this summer we will begin providing ABA services in our Chicago location through Illinois Medicaid Waivers. We will work with relevant agencies in many of the other states in which we operate – Arizona, California, Kansas, Missouri, Ohio, Texas, Wyoming – to ensure that we are best positioned to support families as they seek to expand services.

Specific state updates and clarifications of coverage will be posted to our Trumpet Blog and social media channels in the coming months.

Medicaid families interested in accessing Trumpet’s ABA services can fill out our free online insurance eligibility form at www.tbh.com/insurance.

For more information and updated information on Medicaid’s coverage of ABA therapy services, visit www.medicaid.gov.

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