CMS’s guidance on EPSDT Services for Children with ASD

Executive Summary

In July, 2014, the Centers for Medicare and Medicaid Services (CMS) issued guidance clarifying that evidence-based treatments for children with autism spectrum disorders (ASD), including behavioral and communication approaches to treatment, are eligible for federal financial participation under three State Plan authorities. CMS explained that states are obligated to cover these services for children under 21, even if they are not covered for adults under the State Plan, when they are medically necessary. In September, 2014, CMS issued an FAQ, further explaining states’ obligation to cover services for children with ASD. This fact sheet provides a brief overview of CMS’s guidance, and provides considerations for state advocates working to ensure that children with ASD have access to the services they need.