Lawsuit seeks to force Hawaii’s Medicaid program to cover ABA therapy

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Tuesday, October 7, 2014

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Hawaii ABA Suit

The Hawaii Disability Rights Center and Alston Hunt Floyd & Ing filed a class action lawsuit against the state Department of Human Services last month, on the grounds that it is required under the Medicaid Act to cover the cost of the primary treatment for young people with autism.

“By its refusal to cover the cost of (Applied Behavioral Analysis) treatment under Medicaid, DHS has unlawfully denied critically needed healthcare to children with (autism spectrum disorder),” the lawsuit states. “As a result, these children are less likely to reach their full developmental capacity and are more likely to be institutionalized as adults.”

Nationwide, 37 states mandate that private health insurers cover the cost of ABA therapy, when it is determined to be “medically necessary.”

Under Medicaid’s Early and Periodic Screening, Diagnosis and Treatment program, states are required to cover “medically necessary services” in their Medicaid programs. In a July bulletin, the federal Center for Medicare and Medicaid Services clarified that ABA treatment falls under this provision.

The lawsuit, filed September 5, is on behalf of all Hawaii children under the age of 21 with an autism spectrum disorder receiving Medicaid. It was filed in the U.S. District Court for the District of Hawaii.

Hawaii Disability Rights Center and Disability Rights Washington, which operates this Galaxy website, are part of the federally funded protection and advocacy system and members of the National Disability Rights Network.