Medi-Cal starts covering popular autism therapy

Therapist Laurie Waguespack works with Grant Fulton, who has autism, in Lacey, Washington.
Therapist Laurie Waguespack works with Grant Fulton, who has autism, in Lacey, Washington.
Drew Perine/AP

Medi-Cal will now start covering the cost of a popular autism therapy for thousands of California kids whose families previously couldn't afford it or were paying for it out of pocket, under state regulations that took effect Monday.

The regulations, set up by the California Department of Health Care Services, say Medi-Cal will cover the use of Applied Behavior Analysis, known as ABA. It focuses on behaviors and learning, and on practicing certain skills.  Studies have shown that ABA has produced improvements in relationships, play, school performance and communications, according to the advocacy group, Autism Speaks.

"This is...huge and long awaited good news," said Karen Fessel, executive director of the Autism Health Insurance Project, in a blog post about the change. "This opens the door to critical treatment for thousands of low-income children in California with autism, who have not had access to ABA therapy."

Autism advocates estimate that the families of around 6,000 children on Medi-Cal will be able to take advantage of the coverage. 

"We are very pleased that Medi-Cal will soon provide Behavioral Health Treatment (BHT) services, including ABA therapy, to our members who need them," said Toby Douglas, director of the Department of Health Care Services in a statement. "This is an enormous positive step for many Californians who will soon have access to BHT services for the very first time."

The benefit is retroactive to July 7. Families that have been paying for the therapy out of pocket may be able to get reimbursed if they qualify, according to the Department of Health Care Services.

In early August the state legislature approved SB-946, which paved the way for implementation of the new rules. State leaders were responding to guidance from the Centers for Medicare and Medicaid Services. The agency mandated in July that state Medicaid programs cover a wide range of autism services, including ABA therapy.

The Department of Health Care Services is still working to define the services, set reimbursement rates, set up a delivery system and determine how many children may be eligible. A meeting is scheduled for Oct. 16 in Sacramento.