Plan for Autism Medi-Cal Benefit Rejected

by David Gorn

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The Legislature late last week voted to exclude one type of autism therapy from Medi-Cal by reversing a previous decision to link it with the state's essential health benefit package.

Applied behavioral analysis -- known as ABA therapy -- was part of the language in two nearly identical special session bills: ABX1-1 by Assembly member John Perez (D-Los Angeles) and SBX1-1 by Sen. Ed Hernandez (D-West Covina). The bills had implicitly included ABA therapy as one of the state's essential health benefits -- meaning it would have been covered for those children enrolled in Medi-Cal. Friday the Legislature struck that language from the related bills.

Earlier last week, the Legislature and the governor agreed on a budget deal that included money for mental health care and partial restoration of adult Denti-Cal benefits, but no funding for autism treatment. The Legislature approved the budget package Friday along with the remaining special session bills.

In ABX1-1 and SBX1-1, the deleted portion of Section 14132 of the Welfare and Institutions Code said, in part:

"… to establish a benchmark benefit package that includes the same benefits, services, and coverage as is provided to all other full-scope Medi-Cal enrollees, supplemented by any benefits, services, and coverage included in the essential health benefits package adopted by the state pursuant to Section 1367.005 of the Health and Safety Code and Section 10112.27 of the Insurance Code and approved by the secretary under Section 18022 of Title 42 of the United States Code, and any successor essential health benefit package adopted by the state."

What that paragraph means is that Medi-Cal enrollees would have been entitled to the same essential health benefit package as those covered in the exchange. The essential health benefits in the exchange include ABA therapy.

By deleting that section, the state has indicated it has changed its mind and will not offer ABA therapy to Medi-Cal beneficiaries.

Children's health advocates were dismayed.

"It's extremely disappointing that the state rejected this solution to get children with autism the behavioral therapies they needed to succeed in the world," said Kelly Hardy, director of health policy for Children Now.

"Families with private coverage have access to these therapies to these services, but those with Medi-Cal do not," Hardy said, "and that simply must change."


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