Illinois Medicaid fails to cover ABA therapy for children with autism

To the editor:

It doesn’t take a genius to know something is wrong with our health care system. But the Illinois health care system puts low-income families affected by autism at a distinct disadvantage compared to most states.

Illinois is among seven states that do not cover Applied Behavior Analysis therapy under Medicaid/Early and Periodic Screening, Diagnostic and Treatment, Medicaid's child health component.

EPSDT is defined in federal law and requires coverage for all medically necessary treatments for Medicaid-eligible children up to 21 years old. This means that Illinois Medicaid is essentially ignoring federal law as it relates to coverage for ABA therapy when medically necessary.

The Center for Disease Control estimates one in 54 children in the U.S. has autism.

ABA is considered the standard of care for treatment of Autism Spectrum Disorder (Behavior Analyst Certification Board, 2014) and U.S. Surgeon General David Satcher has endorsed intensive behavioral intervention for individuals with autism.

"Mental Health: A Report of the Surgeon General" states: “Thirty years of research demonstrated the efficacy of applied behavioral methods in reducing  inappropriate behavior and in increasing communication, learning, and appropriate social behavior.”

Regardless of one’s opinion of the level of the government’s involvement in health care, Illinois residents must know about Illinois Medicaid’s failure to follow laws, which is hurting kids right now.

These kids have one life. It’s time we gave them the best chance at that life they can possibly have by giving them access to life-changing therapies that will increase their quality of life.

Sarah Lewis

Sterling