Medicaid and CHIP Must Now Cover Treatments for Children With Autism, Asperger Syndrome, or PDD-NOS

Centers for Medicare & Medicaid Services (CMS) has sent out an informational bulletin directing that all state's Medicaid and Children's Health Insurance Program (CHIP) plans must provide services for children with autism spectrum disorder (ASD). ASD includes autism, Asperger's syndrome, and pervasive developmental disorder (PDD).

The new policy will require states to pay for treatment for autistic disorders for those under 21 under the "early and periodic screening, diagnostic and treatment services" (EPSDT) provision of Medicaid law. The EPSDT benefit requires children and teenagers under 21 to be offered services that are necessary to improve physical or mental conditions. Treatment covered by Medicaid and CHIP may include applied behavioral analysis (ABA -- a type of behavior modification therapy), other behavioral therapies, and medication.

According to the Kaiser Family Foundation, many states' low-income health programs previously didn't cover the high costs of applied behavioral analysis for autistic children and didn't cover any services for children with Asperger syndrome or PDD. In addition, according to Autism Speaks, 37 states and D.C. now require private health insurance plans to cover autism treatment.