WHAT WE DO
INSURANCE & FUNDING INFO
ABA is finally available for children with ASDs on Medi-Cal! Beginning September 15, 2014 low-income families on Medi-Cal may call their health plan and their child's primary care physician and request an assessment for ABA therapy.
In July 2014, the Centers for Medicaid & Medicare Services issued federal guidance to the states indicating that ABA is a covered benefit for children under 21-years-old. This benefit was hard fought for by families, advocates and supportive public officials.
How to get Behavioral intervention therapy (aba)
In order to be eligible, children will need to have a diagnostic assessment of autism spectrum disorder, and a prescription for ABA therapy from either a psychologist or treating physician. The prescribing professional will need to explain why ABA therapy is medically necessary for a child. More information.
SPEECH AND OCCUPATIONAL THERAPIES
Medi-Cal managed care plans are governed by the Knox Keene Act, and must meet the requirement to provide “Basic Health Care Services” as described in Health & Safety code §1367(i) and further elaborated in 28 CCR §1300.67 (a) (1). Speech and occupational therapies are considered basic health care services, and you can argue that you are entitled to these medically necessary services if you are in a Medi-Cal managed care plan and they attempt to deny or limit the number of sessions that you receive.
We encourage you to obtain a letter from your child’s physician attesting to the medical necessity of these treatments.