ABA Coverage: A Need for Change

In the United States, the CDC has estimated that Autism affects about 1 in 68 children.  Children with autism who are not properly diagnosed or do not receive the proper treatment miss out on effective interventions during critical periods of development resulting in permanent and varying developmental and neurological delays.  This is a devastating reality for many children who are not diagnosed early on in life or children who may never receive a proper diagnosis at all. Even more distressing are children who are diagnosed at an early age, recommended for scientifically proven effective interventions like ABA therapy by their physicians, but are still unable to gain access to services.

Many families are faced with the reality of not having access to the services they need, even though they are immensely aware these services are needed and services exist as an effective treatment but are just out of their reach.  This is a reality that many families in the state of Illinois are faced with.  It’s hard enough, walking out of a doctor’s appointment with a diagnosis of autism, a recommendation page a mile long, and the overwhelming feeling of wanting to do everything in your power to help your child, only to be told that what’s best for your child is not covered under your current insurance policy.  They are given the proper diagnosis at an appropriate time in their development in order to successfully receive an intervention that has the potential to make them indistinguishable from their peers, and yet many of those children are not given access to the funding needed for the interventions because their insurance policies are state funded.

The state of autism laws in the state of Illinois has recently been brought to the forefront. More specifically, the rules and regulations regarding ABA coverage for Medicaid recipients have been brought to light and there are major discrepancies in autism coverage for private health insurance policyholders and those with Medicaid. These are actual violations of Illinois law dating back to its origination in 2008.

The state of Illinois passed the Illinois Autism mandate near the end of 2008. At the time, even private insurance companies attempted to deny the legislation of coverage for ABA for children with autism for years following this passage. It was only as recently as 2017 that private insurance companies had an official policy regarding autism/ABA coverage within the state of Illinois. Even though the law passed in 2008, it took another nine years before it was officially and formally acknowledged.

Now, we have a new challenge. For many families residing in Illinois, proper autism treatment is still too far out of reach. The necessary treatment for children with autism that fall into the Medicaid category simply do not receive it in our beloved state. It is time for parents to stand up and take what is crucial for their children. No longer in the state of Illinois should it be acceptable for a child with autism to be deprived of the most necessary and basic form of care available to them. The time has come for all parents in Illinois to be reassured that socio-economic status will not preclude them from appropriate and essential interventions.

There should be no question in 2019 about what is medically necessary for children, adolescents, and adults with developmental disorders. Applied behavior analysis (ABA therapy) is the only medically recommended therapy by the U.S. Surgeon General in the last two decades. The conversation should no longer be about what to do; it should be about how to obtain it for your child.

We here at Applied Behavioral Consulting, are here to spread awareness about autism and answer any questions that you may have. For more information visit www.abcbehavioraltherapy.com or give us a call at (630) 402-6060.