Autism Benefit Services

“Caregiver involvement is integral!”

What is the Medicaid Autism Benefit?

The Autism Benefit provides intensive Applied Behavior Analysis (ABA) for Medicaid individuals under the age of 21 who meet eligibility and medical necessity criteria. The service is  for both individuals with Autism Spectrum Disorder (ASD) and their caregivers.  ABA services are not intended to replace services provided in school or other settings.  Each program is individualized to meet the needs of the individual and family .


What level of service is delivered under the Autism Benefit?

The Autism Benefit is an intensive Applied Behavioral Analysis program.  There are 2 levels to be provided in office, home, and community dependent on where the individual displays areas of need.

  1. Focused Behavioral Intervention: services provided average 5-15 hours per week
  2. Comprehensive Behavioral Intervention: services provided average 16-25 hours per week


How do we know if an individual meets ‘medical necessity’?

A series of testing by specially trained professionals occurs to determine this.  The individual must demonstrate substantial functional impairment in areas of social communication and social interaction in all of the following:

-deficits in social-emotional reciprocity

-deficits in nonverbal communicative behaviors

-deficits in developing of relationships

The individual must also demonstrate substantial behavioral limitations in at least two of the following:

-Stereotyped or repetitive motor movements

-use of objects or speech

-inflexibility in routines, fixated interests

-sensory issues in aspects of the individuals environment


What additional things can I expect in the program?

Expect that you as a caregiver will be requested to be present and to participate in a portion of the treatment on a frequent basis.  Caregiver involvement is INTEGRAL!  Without this, the Applied Behavior Analysis is not nearly as effective.  Outside of the initial assessments to determine eligibility, there will be some ongoing assessments at scheduled intervals to measure progress.  There will be coordination with the primary care physician, school, and other community agencies also providing services