January 30, 2019
FOR IMMEDIATE RELEASE
Oklahoma City, OK- Today, Administrative Law Judge, Joseph H. Young, issued a decision on a hearing held in December 2018 compelling the Oklahoma Health Care Authority (OHCA) to cover Applied Behavior Analysis (ABA) Therapy for children covered by the state’s Medicaid program, SoonerCare.
Brian Wilkerson, Director of Litigation and Legal Services for ODLC said, “While state law has required private insurers to cover ABA therapy for children since 2016, Oklahoma’s Medicaid program has continued to deny coverage.”
Judge Young ordered the OHCA to cover ABA therapy under Medicaid’s EPSDT (Early Periodic Screening Diagnosis and Treatment) benefit for children under age 21. Under the EPSDT mandate, States are required to arrange for and cover any Medicaid coverable service listed in Section 1905(c) of the Social Security Act that is determined to be medically necessary for individuals eligible for the EPSDT benefit.
Kendra Webb, mother of ODLC’s client, stated “We are thrilled the OHCA is finally providing this much needed therapy to our child, and we hope that in the near future all children with Autism Spectrum Disorder covered by SoonerCare will be able to access this benefit.”
“While this order is specific to our client,” said Joy Turner, attorney with ODLC, “we believe Judge Young’s order makes it clear that the OHCA must cover ABA therapy, when medically necessary, for all children covered by EPSDT.”
The Oklahoma Disability Law Center is the federally funded Protection and Advocacy agency for Oklahoma. ODLC provides free legal services to persons with disabilities, monitors facilities to prevent abuse and neglect, and is especially focused on systemic issues.
“ODLC will continue to push for systemic changes that will ensure all families in need of such vital services as ABA therapy are able to receive them”, said Brian Wilkerson.
Brian Wilkerson, Director of Litigation and Legal Services, Oklahoma Disability Law Center
Copy of the order is available on our website: OHAC ABA Final Order 1-30-19 – Redacted
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