Judge: Florida Medicaid Must Cover Therapy for Autism

Posted: Published on March 27th, 2012

This post was added by Dr Simmons

Published: Tuesday, March 27, 2012 at 2:18 a.m. Last Modified: Tuesday, March 27, 2012 at 2:18 a.m.

LAKELAND | Florida's Medicaid program must cover applied behavioral analysis for children who are diagnosed with autism and related disorders, a federal judge in Miami ruled Monday morning.

An estimated 8,500 Florida children on Medicaid are identified now as having full-blown autism or related conditions falling under the umbrella of autism spectrum disorder. The decision will benefit them, along with other children diagnosed with those disorders in the future who need behavioral health therapy.

U.S. District Court Judge Joan Lenard called the state's decision not to cover ABA therapy "arbitrary, capricious and unreasonable, both in its process and in its conclusion."

The Florida Agency for Health Care Administration didn't follow its standard process for determining whether a treatment or service should be covered when it ruled against applied behavioral analysis. It didn't apply the state's definition of experimental and failed to use "reliable evidence" as defined by Florida law, Lenard said in the permanent injunction order against the state agency.

The agency has a month in which to appeal the injunction if it chooses to do so.

"We're so excited about the decision," said Betsy E. Havens of Florida Legal Services Inc. in Miami.

"We think it will help pave the way for a lot of other state Medicaid programs."

Havens is one of the lawyers representing three autistic children in Dade County who were denied Medicaid coverage of ABA therapy despite having been referred for it by the neurologists treating them.

Autism is a developmental disability significantly affecting verbal and nonverbal communication and social interaction that adversely affects a child's educational performance, according to a federal definition. It usually is evident before age 3.

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Judge: Florida Medicaid Must Cover Therapy for Autism

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