Autism New Jersey’s Advocacy Leads to Medicaid Rate Increase for ABA Services

The Department of Human Services (DHS) Division of Medical Assistance and Health Services (DMAHS) announced today that they will be increasing the reimbursement rate for applied behavior analysis (ABA) technician services covered by NJ FamilyCare.

The rate for behavior technician services under the ABA benefit was $11.20 per 15-minute increment ($44.80/hour) and is now $15 per 15-minute increment ($60/hour).

Autism New Jersey’s collaborative efforts with DMAHS to launch the benefit provided a strong foundation for continued advocacy on the benefit’s implementation.

Our 800.4.AUTISM Helpline has been tracking families’ experiences since the ABA benefit was launched  on April 1, 2020, with frequent calls from concerned parents who were unable to find a provider to deliver these services. Upon hearing families could not access the benefit due to an inadequate provider network, Autism New Jersey set out to understand the specific reasons why many behavior analysts were not joining the Medicaid network. We learned that their primary concern was the below-market behavior technician rate.

Autism New Jersey’s Public Policy team then met several times with colleagues at DMAHS to express concerns regarding the negative impact of the low reimbursement rates – specifically, the technician rate – had on the provider pool and, more importantly, on children with autism. DMAHS officials agreed with our recommendation to increase the technician rate and submitted the increased rate to the federal government under a portion of the American Rescue Plan that would enhance services provided by NJ FamilyCare.

After months of anticipation, the federal government approved the rate increase, which went into effect today.

“Removing systemic barriers so that children with autism, especially those from low-income families, can access medically necessary treatment has been our highest priority,” noted Autism New Jersey Executive Director, Dr. Suzanne Buchanan.  “We are grateful for DMHAS’s tangible commitment to children with autism as this rate increase will encourage more providers to serve NJ FamilyCare beneficiaries.”

“A rate increase for autism services within NJ Family Care plans is great news for families, providers and community advocates alike,” said Matthew Hess, CEO of First Children Services. “Access to care, particularly early diagnosis and treatment, is absolutely imperative for the long-term positive outcomes of this population. The rate increase will allow for broader provider networks and higher quality of care for this traditionally underserved community. Kudos to the state of New Jersey for making this commitment and our partners at Autism New Jersey for their tireless advocacy for families and children.”

Autism New Jersey is truly grateful to Department of Human Services (DHS) Acting Commissioner Sarah Adelman, DHS Assistant Commissioner and Division of Medical Assistance and Health Services (DMAHS/Medicaid) Director Jennifer Langer Jacobs, Medicaid Deputy Director Carol Grant, and Medicaid Chief of Behavioral Health and Customer Service Steven Tunney for working closely with us on this initiative and systematically building capacity to meet the needs of the autism community.

We look forward to continuing to work closely with DMAHS to ensure that NJ FamilyCare families have access to quality ABA services throughout the state.

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Autism New Jersey’s 800.4.AUTISM Helpline specialists will be happy to help you understand Medicaid/NJ Family Care and what coverage is available for your child.