Medicaid/NJ FamilyCare Preparing to Cover ABA for Children with Autism

April 06, 2020


EPSDT Medicaid Autism benefit delayed

As many of you are aware, the Department of Human Services and its Division of Medical Assistance and Health Services (DMAHS, aka Medicaid) had announced and been planning for an April 1, 2020 launch of their EPSDT Medicaid Autism benefit.

Unfortunately, but understandably, the COVID-19 crisis has caused a delay to this time frame. As we have been throughout the path to this important benefit, we are in contact with Medicaid officials and have offered our continued assistance to ensure this benefit goes live as soon as possible. We are expecting an update in the coming weeks and will post that information as soon as we receive it.

Original article posted May 6, 2019

In the coming months, children whose health insurance is NJ FamilyCare will be able to access coverage for ABA services. As described in this article, the state’s publicly funded health insurance program is responsible for ensuring that children under age 21 have access to comprehensive high-quality health benefits. Autism New Jersey commends Governor Murphy, Commissioner Carole Johnson, and Medicaid Director Meghan Davey who are committed to launching this benefit on behalf of the estimated 20,000 children with autism whose health insurance is NJ FamilyCare.

What’s Happened So Far?

Public input requested and plan submitted

The State of New Jersey organized a stakeholder group that met throughout the summer and fall of 2018 to discuss the treatments and provider qualifications that would be included within this benefit. The state also held an open forum and requested public input. The recommendations from the stakeholder group and public comment were used to create a formal document called a State Plan Amendment (SPA) to add this coverage to the state’s existing Medicaid contract with the federal government to secure federal funding. The SPA was submitted on March 29, 2019. Federal approval is possible within the next few months, and then state regulations will likely be drafted and shared for public comment.

What’s Next?

Waiting for access and joining our email list

Once the SPA is approved and operationalized, Medicaid/NJ FamilyCare-eligible individuals will be able to access coverage for ABA services. While we don’t know when the benefit will be available, you can call us for more information and receive updates by joining our email list:

Autism New Jersey helps all families understand the eligibility criteria for a variety of services. We have been and remain committed to helping Medicaid-eligible families access the EPSDT benefit. We can help you understand this and other ways to access services.