Q&A: CMS Guidance on EPSDT Services for Children with ASD in Medicaid

Executive Summary

Under longstanding Medicaid law, the state Medicaid agency must cover particular treatments “including intensive behavioral services” if they are coverable Medicaid services, necessary to correct or ameliorate a child’s ASD, and no alternative, equally effective treatment is appropriate for the child. A recent CMS guidance letter and FAQ discuss coverage of services for children with ASD. They do not require states to cover ABA therapy per se; however, they suggest that, if the state does not cover ABA therapy under EPSDT, it must cover comparable services that are expected to achieve comparable outcomes.