What is Medicaid?
Medicaid is a federal program meant to help people who need health care but can't afford to pay it. If your family meets financial guidelines, you could quality right away.
However, if you don't, then you may need to provide proof that one family member has a disability that qualifies them for Medicaid insurance coverage for ABA therapy.
If you're accepted into the Medicaid insurance coverage program, you can get financial assistance for the treatments you or your child needs.
Medicaid is considered a good form of insurance, and people with Medicaid are able to get coverage equal to or better than what private programs offer.
However, there are some disadvantages to using Medicaid compared to other insurance providers that you should know about as you consider if it's the right provider for your family.
How Does Medicaid Work?
Medicaid can be understood as a project that's shared by federal and state governments. They both contribute money to keep the project going, and both have a say in how the money is used.
Medicaid is based on two guarantees:
- Coverage - People who meet financial requirements will get help.
- Funding - States pay for qualified services for people who are eligible for Medicaid insurance coverage. The money spent by the states get matched by the federal government. Certain states get a 50/50 match, and others get more or less.
States have the ability to:
- Determine what things are covered
- Set limits on other types of care
And they must cover certain mandatory populations, including:
- Children from low-income families up to age 18
- Pregnant women from low-income families
- Caregivers or parents from low-income families
- Individuals with disabilities or seniors who receive financial assistance through the Supplemental Security Income (SSI) program.
In general, it's important that you must use providers that accept payments from Medicaid. Keep in mind that not all doctors, hospitals, and health clinics are able to accept that form of insurance.
Therefore, if you go further than the network Medicaid uses, you could be stuck in a situation where some or all of the bill needs to paid out of pocket. Now that you know how Medicaid works, you'll now learn about how to apply.
Read More: Financial Assistance For Autism
How to Apply for Medicaid
ABA therapy is the gold standard of treatment for people diagnosed with autism.
As a parent, you might enroll in Medicaid to pay for that care, which can cost $120 per hour if paid out of pocket. There is a gray area for families to have ABA covered in some states.
Therefore, you should confirm that a particular type of therapy is covered by Medicaid before you commit.
Doing so will help prevent financial hurtles in the future.
To apply for Medicaid in your state, choose one of the two methods listed below, which are recommended by The Centers for Medicare and Medicaid Services to use:
- The Health Insurance Marketplace. This is the website families use to purchase insurance. It comes with subsidies from the federal government, and it's an online application where you must answer several questions. You will find out right away if you qualify.
- Your state Medicaid agency. Some families might be uncomfortable using computers to fill out important forms, and if that's the case, you should contact the Medicaid agency in your state. Meet with a qualified expert to discuss your eligibility for insurance coverage.
Warning: Be careful when applying for Medicaid, because if you qualify, you can't decline the offer and ask for subsidized health insurance. Insurance experts say that the program doesn't work that way.
Overall, applying for Medicaid should be a straight-forward process if you follow these steps, and your family will receive significant financial assistance from the insurance provider if you qualify.
How Do States Use Medicaid for Applied Behavior Analysis?
Coverage varies widely depending on which state you live in. Here's a breakdown of how a few states deal with requests to cover autism therapy:
- North Carolina: The Medicaid authority in North Carolina recognizes that ABA could be right for some people, but the organization states that some people could benefit from other forms of treatment. Therefore, in this state, coverage isn't guaranteed.
- Texas: In 2019, the governor signed a budget bill that mandated Medicaid coverage for ABA therapy, including other forms of autism care.
- Washington: Here, ABA therapy is covered by Medicaid for people ages 2-20.
- Utah: In this state, there are available ABA benefits. However, they must be provided by someone who is specifically trained to provide autism treatment.
There is a comprehensive list of all state offices on medicaid.gov. For more information on how ABA therapy is covered in your state, you can contact the department in your state.
Here are the most common limits when using Medicaid as your insurance provider:
- Denials - The plan won't cover therapies that aren't delivered by a certain type of professional, or your state may cover only one type of treatment for autism.
- Political battles - Treatment providers must accept Medicaid payments, but sometimes, families aren't able to find anyone to care for their autistic children because of the low reimbursement rates offered by Medicaid.
- Age limits - Once people celebrate their 21st birthday, most benefits we've discussed end. Even when adults still qualify for Medicaid, they don't have access to comparable programs as children ages 1-21 do.
Medicaid Benefits For Autism Therapy
To conclude, insurance coverage through Medicaid is worthwhile and beneficial for qualifying families. The biggest benefits of coverage your family could experience are:
- Family members can return the workforce, which could give your family a big economic boost.
- Family members can receive good health care.
- Family members with Medicaid coverage have a lower risk of paying large out-of-pocket expenses compared to people with private insurance coverage.