ODLC engages in systemic advocacy as a means of achieving our mission of protecting, promoting and expanding the rights of people with disabilities in Oklahoma. Through systemic advocacy, we seek to influence and change systems such as legislation, government or agency policy, services practices and community attitudes.
In order to effectively address systemic issues, ODLC often needs people directly affected by a particular problem or issue to contact our office and share your experience with our staff who are working on long term solutions.
Please review the projects listed on this page. If you believe you can assist our office with any of these projects please contact us.
If you are aware of other systemic issues you think we should address, please contact us.
Medicaid Coverage of ABA and Other Therapies for Children
- The Oklahoma Health Care Authority (OHCA), Oklahoma’s Medicaid agency, is required to provide coverage for ABA therapy to all Medicaid eligible children under age 21, when determined to be medically necessary.
- In July 2014, The Center for Medicare and Medicaid Services (CMS) issued a memo to all state Medicaid agencies, including OHCA. The memo makes it clear that services for children with Autism are subject to the same longstanding requirements for all children under the age of 21.
- All Medicaid eligible children under age 21 are covered by the Early Periodic Screening, Diagnosis and Treatment (EPSDT) benefit, states are required to arrange for and cover for individuals eligible for the EPSDT benefit any Medicaid coverable service listed in section 1905(a) of the Act that is determined to be medically necessary to correct or ameliorate any physical or behavioral conditions.
- If a service, supply or equipment that has been determined to be medically necessary for a child is not listed as covered (for adults) in a state’s Medicaid State Plan, the state will nonetheless need to arrange for and cover it for the child.
- The Letter also states that EPSDT services for children with Autism (such as ABA services) may be covered under several different benefit categories including ‘services of other licensed practitioners,’ 42 U.S.C. §1396d (a) (6); ‘preventive services,’ 42 U.S.C. §1396d (a) (13); ‘therapy services,’ 42 U.S.C. §1396d (a) (10). The Letter provides a detailed discussion of each category.
- This issue has been litigated in several other states dating back as far as at least 2008. The Courts have consistently held:
- ABA can be a medically necessary treatment for Autism
- ABA is a covered service under EPSDT
- Medicaid agencies must provide coverage of ABA when medically necessary
- Parents League for Effective Autism Services, ET. al. v. Jones-Kelly, 339 F. Appx. 542 (6th 2009)
- KG v. Dudek, 864 F. Supp.2d 1314 (S.D. Fl. 2012), aff’d in part, vacated in part and remanded, 731 F.3d 1152 (11th Cir. 2013). On Rehearing, 981 F. Supp. 2d 1275 (S.D. Fl. 2013)
ODLC is working to ensure Medicaid eligible Oklahoma children are receiving ALL medically necessary services. If you or someone you know has a child who is a SoonerCare recipient and the child’s doctor has determined ABA therapy is a medically necessary treatment for this child, please call our office at 800-880-7755.
Help us get the word out! Download and distribute the ODLC Handout: MEDICAID COVERAGE OF ABA AND OTHER THERAPIES FOR CHILDREN
Hepatitis C treatment for Oklahoma Inmates
ODLC has a growing concern over the almost non-existent treatment of Hep C for the over 2700 Oklahoma inmates who have this potentially deadly disease.
This growing problem was recently highlighted in an this article by Oklahoma Watch: Only a Handful of Prison Inmates Get Treatment for Deadly Disease
If you or someone you know is in DOC custody and are being denied treatment for Hep C, or were recently released after being denied treatment for Hep C, please please call our office at 800-880-7755.