Effective February 1, 2022, ABA became a covered benefit under Texas Medicaid.
This groundbreaking change will impact families across Texas and allows children ages 20 and under who have Medicaid to receive coverage for ABA services.
This effort was accomplished through several years of advocacy and public policy work by various people including members of the BlueSprig Team and our external partners on behalf of families and children in the state of Texas. In May of 2019, Governor Abbott passed a bill that announced the approval of Medicaid coverage for ABA. But in September of 2020, when the rates were released, they were too low for providers to be able to afford the cost of providing high quality care to these children, meaning they would not get the coverage they needed after all. Our advocates knew it was time to take immediate action.
“Advocacy is important so both policy and law makers can understand the scope of impact the healthcare programs have on their constituents,” says Rebecca Womack, Associate Vice President of Clinical Standards. “BlueSprig embraced every opportunity to strategically engage with policy makers, law makers, and agency representatives in an effort to provide education how to safeguard the delivery of quality ABA services.”
The long-term goal was to increase the reimbursement rate so credible ABA providers like BlueSprig could service children with Medicaid coverage. By contacting Governor Abbott, writing to the media, collaborating with champions in the house and in the senate and attending public hearings, the hard work of our team and those who worked alongside paid off with this victory of Texas Medicaid covering ABA therapy. We can all celebrate with hope and excitement that providers are now able to accept the rate and more children will be able to access care.
What This Means for Families & The Industry
With this new change, almost every single group across the state will have access to ABA therapy. Not only do families receive gain from this amazing benefit, but Texas-based diagnosticians, neurologists, psychologists, and psychiatrists are able to refer their patients with Medicaid benefits to ABA services. The ABA industry benefits because now we can attract greater talents and be more inclusive in who receive our services. More importantly it is our hope for families to see a decreased waitlist time for services so they can access the care they need sooner.
We encourage families to continue advocating and using their voice to bring about change in their communities for their loved ones. “I don’t think that our families realize how much power they have. They can absolutely change the world for their child, for their friend’s child, for their neighbor’s child, just by being willing to tell their story,” says Mariel Fernandez, President of the BlueSprig Advocacy Committee. “That truly is how this has happened. One person has so much power if they’re willing to do it.”
What You Need to Know About Texas Medicaid ABA Coverage
Texas Medicaid ABA coverage is new and there are a few specifics to highlight.
- At this time, BlueSprig, like many other providers in Texas, is in the contracting and credentialing phase that can take up to 180 days.
- BlueSprig is actively working with the sixteen Managed Care Organizations (MCOs) across the state to ensure that families with Texas Medicaid coverage who are seeking ABA services will be able to take the next steps in the onboarding process with BlueSprig. Families will be able to contact their MCO to get a list of providers or specialists who are able to help them with services, at that point the MCO will authorize ABA services.
- The onboarding process on average can take 30 days or longer.
- A medical provider must complete your comprehensive evaluation.
- A full individual evaluation (FIE), completed by a school district professional will not be equivalent to the comprehensive evaluation.
- The evaluation must not be older than three years old and must include a standardized assessment tool, such as GARS, CARS, ADIR, or ADOS with the severity level included. The DSM has a breakdown of three levels and the diagnostic report must specify.
- We are aware that most diagnosticians do not include the level in their report, and as a result, if a family signs a release of information, BlueSprig can communicate with the provider on their behalf.
How You Can Get Started
We look forward to extending our services to even more families in Texas. If you want to learn more about starting ABA services with BlueSprig, please reach out to your local center! Each of our Texas centers is ready to serve you and your family in 2022!