ABA Medicaid Benefit: Year Three Update

Three years ago, Medicaid/NJ FamilyCare began covering medically necessary Applied Behavior Analysis (ABA) treatment for children under 21. Autism New Jersey played a pivotal role in advocating for this expansion, which changed the treatment landscape for thousands of New Jersey families.

Covering medically necessary ABA therapy for Medicaid member children helps rehabilitate systemic inequities in autism treatment and removes a substantial healthcare barrier for low-income and ALICE families.

Despite its launch coinciding with the height of the Coronavirus pandemic, the ABA therapy benefit under Medicaid has steadily expanded access to care. In each successive year the number of paid ABA claims has gone up, the number of denied claims has gone down, and the number of in-network ABA therapy provider agencies has increased.

Department of Human Services (DHS) and Autism New Jersey Quickly Responded to Bottlenecks

In planning the release of this benefit, DHS Division of Medical Assistance and Health Services (DMAHS) could not have foreseen the challenges that would be posed by the pandemic. COVID dominated media attention at the time and overshadowed the launch of this important benefit. To help spread the word, Autism New Jersey created guides for parents and providers that walk them through enrollment processes and help them navigate real-world challenges. DMAHS followed suit, publishing the Family Guide to Autism Services Funded by Medicaid/NJ FamilyCare.

Network adequacy also emerged as an early and ongoing obstacle. Some families reported to our 800.4.AUTISM Helpline that it was difficult for them to find an in-network provider near their homes and others reported long waitlists. We reached out to behavior analysts from around the state and learned that their primary concern was the below-market behavior technician rate.

Autism New Jersey’s Public Policy team met with colleagues at DMAHS to express concerns regarding the impact of the low reimbursement rates on Medicaid’s provider networks. DMAHS officials agreed with our recommendation to increase the technician rate and submitted the increased rate to the federal government, ultimately bringing the rate from $44.80 per hour to the current, and much more competitive, $60.00 per hour rate for behavior technicians.

More Access to Medically Necessary ABA

As data become available about the third year of the Medicaid/NJ FamilyCare ABA benefit, exciting trends emerge. In the last three months of 2022, we have seen both the greatest ever number of ABA approved claims (88,771) and the lowest number of denied claims (5,784) since the benefit’s inception in April 2020.

As 2022 came to a close, the number of Medicaid members who are currently receiving ABA therapy also reached a new high. Coupled with the January 1, 2023 launch of Cover All Kids, under which families can apply for NJ FamilyCare for their children regardless of immigration status, low-income and socio-economically disadvantaged families are able to access medically necessary ABA therapy.

Autism New Jersey’s Advocacy Continues

The combined efforts of DMAHS, providers, and advocacy organizations like Autism New Jersey are contributing to a more equitable system, in which individuals with autism have better access to essential healthcare and treatment. Nevertheless, our advocacy around healthcare, funding, and direct service provider workforce development continues.

We remain dedicated to ensuring safe and fulfilling lives for individuals with autism, their families, and the professionals who support them. While that includes focusing on large-scale goals through state policy change, we are also committed to helping individuals with our website content and through our helpline. If you need help with insurance-funded autism treatment, visit our new insurance hub, call us at 800.4.AUTISM, or email us at information@autismnj.org.