Judge: Florida’s Medicaid program must cover Applied Behavioral Analysis

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News from Florida

The U.S. District Court for the District of Florida ruled March 23 that the state of Florida’s policy of not providing health care coverage for Applied Behavior Analysis for children with autism is “arbitrary and capricious,” and ordered the state to begin providing treatment for Medicaid-eligible children who have been recommended for the program by their doctors.

The state argued that ABA is “experimental” and therefore not a “medically necessary” service that it is required to provide under the federal Medicaid Act.

Noting that ABA has been the standard therapy for treating children with autism since the 1990s, the court accepted the plaintiff’s argument that ABA is necessary to aid children with autism – often from as young as age 3 and through age 12 – with their intellectual functioning, language development, acquisition of daily living skills and social functioning.

“Plaintiffs have established through their expert witnesses that there exists in the medical and scientific literature a plethora of peer-reviewed meta-analyses, studies, and articles that clearly establish ABA is an effective and significant treatment to prevent disability and restore developmental skills to children with autism and (autism spectrum disorder),” according to the opinion.

The court further chastised the state’s procedure for determining that ABA was unnecessary.

“No analyst and/or nurse in (the Agency for Health Care Administration) ever reviewed any “reliable evidence” about ABA, no one assessed whether ABA was covered by other states’ Medicaid programs, Medicare, or commercial insurance, no one consulted with any physician about ABA, and no memorandum regarding ABA was ever prepared by an analyst and reviewed by AHCA’s management,” the court stated. “Instead, (AHCA Deputy Secretary Elizabeth) Kidder took on the role of analyst for the purpose of this litigation, and upon a cursory review of these materials, decided that ABA was experimental.”

The lawsuit combined three lawsuits filed by parents of children with autism filed between February and October 2011.

“I’ve sat on the federal bench — March 1st, it was 16 years. This case, if not the most important, is one of the most important cases that I have ever heard,” Judge Joan Leonard said of the ruling, according to a news release from Autism Speaks.