Access Challenges Explained

What specifically is causing access challenges for families from getting access to ABA today?

Medicaid coverage for applied behavior analysis (ABA) therapy for the treatment of autism spectrum disorder (ASD) is available in Ohio. However, there are some access challenges. Currently, Ohio does not have a uniform state-wide well-defined medical policy for ABA therapy for the treatment of ASD, which leads to unnecessary service denials for families and frustration for providers and insurers.

Children on fee-for-service or traditional Medicaid may find it difficult to find providers to serve their children. Many are accessing ABA through a CPST or TBS service within a community behavioral health center. Children enrolled in a managed care plan have ABA coverage and a process to authorize services but may find a limited network of providers.

Some ABA providers find it difficult to become enrolled as Medicaid providers and many struggle to submit claims and receive payments from the newly developing Medicaid claims system.

Some families are experiencing partial denials on hours or service visits and some families of early teens and adolescents ages are getting denied just based on their child’s age.