Before last week, Applied Behavior Analysis (ABA) services were covered under North Dakota’s Autism Spectrum Disorder Medicaid Waiver to only children age 7 and younger. Applied Behavior Analysis is a therapy option for individuals with autism that focuses on positive reinforcements to understand behaviors and principles that explain how learning happens. Applied Behavior Analysis has many benefits for individuals with autism including improving social skills, increasing positive behaviors, and reducing language barriers. It has been shown to improve the overall quality of life for individuals with autism.

Unfortunately, North Dakota is one of the few states that do not mandate private insurance companies to offer ABA therapy services for individuals with autism. According to Minot Daily News, The North Dakota’s State Department of Human Services announced that the Centers for Medicare and Medicaid Services (CMS) will now offer ABA services for Medicaid eligible individuals with autism age 21 and under. This is a major breakthrough in North Dakota for individuals and families affected by autism!

Families eligible for ABA services through Medicaid will need proof of autism spectrum disorder diagnosis, a current Medicaid Early and Periodic Screening Diagnostic Treatment (EPSDT) test, and recommendation from a primary care provider. Fortunately for many individuals, ABA therapy will be available without a waiver now. The Medicaid expansion is expected to match with the opening of new waiver slots as well. The waiver will expand eligibility to a larger group of individuals with autism.

The ABA therapy coverage was only available through a waiver system that provides coverage for a small portion of the eligible individuals. “Having these in the waiver, where we had a finite number of slots, did not afford children access to service if it were determined they had need for that,” Maggi Anderson, Director of Medicaid Services for North Dakota Human Services, told the Grand Forks Herald. There were just not enough spots for the amount of people with autism that need the waivers in the state. Now due to the Medicaid expansion, the waiver will now take into account the income of the child who would be receiving services. These new waiver criteria will provide more opportunities for families to become eligible for ABA therapy. In addition, the state will be working on bringing trained and licensed ABA therapists to accommodate for the amount of people living in the state with autism. North Dakota currently does not have any ABA licensed specialists throughout the entire state. This major Medicaid expansion will provide more opportunities and expand resources for individuals and families affected by autism.

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