Challenge: ABA in Ohio Medicaid
#OHMedicaidABA – Reach out today and Educate! Call, email or grab a cup of coffee in your district! Find My Ohio Senator & Representative. Please consider sharing the outcomes from your discussions with Marla Root at the Ohio Autism Insurance Coalition by calling 614.565.5765 or through our contact page.
The Ohio Medicaid State Health Plan needs a benefit for individuals with autism prescribed intensive behavioral treatments using Applied Behavior Analysis (ABA) treatment.
- Currently, Ohio is one of only eight states without an EPSDT benefit for intensive treatments such as ABA.
- All surrounding states to Ohio have benefits!
- A total of 42 states offer ABA benefits to fund treatment in Medicaid.
- For children ages 0 to 21, our state needs an EPSDT Medicaid Health Plan ABA benefit
- We can accomplish this without legislation through the CMS/Federal Medicaid July 7, 2014 information bulletin stating ABA treatment is now required and can be reimbursed through Preventative Services.
- Currently, some Medicaid members with autism are getting ABA services through member specific single case agreements through managed care plans but these out of network services are not an EPSDT state benefit. This is causing massive access issues with some Medicaid members being discharged or turned away from treatment due to lack of payment on authorized claims from the managed care plans.
- For adults ages 21 and over, our state needs a benefit to fund Periodic & Focused ABA Interventions through the Medicaid system.
- Focused ABA treatments target a certain number of behavioral targets and a limited number of key skills needed to support the individual at that moment in time.
The Request: Please ask your legislator to reach out to any of the following contacts to learn more: Ohio Department of Medicaid, Director Maureen Corcoran and The Ohio Autism Insurance Coalition http://www.asdohio.com. Share the Disability Scoops article dated February 14, 2019, Link
More about EPSDT! The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid. EPSDT is key to ensuring that children and adolescents receive appropriate preventive, dental, mental health, and developmental, and specialty services. Source Link to learn more.
Need for autism-specific Residential Mental Health Treatment (RMHT) Facility in Ohio
Many of Ohio’s children with autism who have very challenging aggressive and/or self-injurious behaviors are sent out of state for RMHT. Ohio has incredible clinical expertise in this population and is in desparate need for a facility that has the autism-specific behavioral expertise and trained staff to meet these children’s complex needs. Marla Root, the Coalition’s founder and director, has experience with this issue through her own son and has case managed hundreds of cases for this population. There is a parent group working together on this issue. If you had a family member that was sent out of state or your family lingered in crisis in your home because you could not find an appropriate RMHT facility for your child, the parent group invites you to join the group. Please contact the Coalition through our contact page and we will get you in touch with the parent group.
Multi-System Youth Challenges – the need to give up custody to access treatment needs to stop!
The Coalition is a part of the Multi-System Youth Coalition here in Ohio that is advocating to end the requirement of custody relinquishment to access treatment. When a family’s employer-based insurance denies access to pay for stabilization treatment, many families have to give up custody to their county’s children services to access a funding source to pay for room and board expenditures in a residential mental health treatment facilities. We are very pleased to see Governor DeWine and his cabinet leaders really looking for ways to support families. We are extremely grateful to see legislator’s listening to families and making statements that we need to find a way to stop custody relinquishment to access treatment in Ohio. If my child has cancer, I as a parent, do not give up custody to children services to get access to medical benefits.
Budget information from The Center for Community Solutions, https://www.communitysolutions.com/research/ohios-2020-2021-state-budget-introduced/
The Joint Legislative Committee on Multi‐System Youth (MSY) was created in the state budget bill from 2016 through 2017. The committee was tasked with examining issues facing youth who are in need of services from, or are involved with, two or more of the following:
- The child welfare system
- The mental health and addiction services system
- The developmental disabilities services system
- The juvenile justice system
The overall goal of the legislative committee was to understand the issues these children and their families face and how to address them holistically, with a focus on preventing children and young people from being removed from their families or custody relinquishment in cases where the family has no other means to pay for treatment services for their child’s multiple needs. The committee made recommendations after seven public hearings. These recommendations were released publicly in June, 2016. While none of the recommendations from this report are formally integrated into the administration’s budget proposal, $25 million in each fiscal year was identified in the ODJFS budget to provide services for children in the custody of child welfare agencies and for children at-risk of entering the custody of child welfare. There are also line-items dedicated to multi-system youth in both the Departments of Medicaid’s and the Department of Developmental Disabilities’ budget. This issue has been discussed during budget testimony before the House Finance Committee and subcommittee on Health and Human Services. Parts of the Joint Committee’s recommendations may be integrated into the House’s version of the budget and there is the prospect of dedicating a funding stream to MSY.