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A Guide for Medicaid

Medicaid Autism Mandate:

A how-to guide provided by Catalyst Behavior Solutions.

  1. Insurance: understanding which Medicaid insurance plan is being used.
  • ASD Services:
    ASD services non-cover benefits under traditional Medicaid only available under the early period screening diagnosis and treatment program any child under 21 who is on traditional Medicaid in this program. For more information on the Medicaid program for youth, visit: https://medicaid.utah.gov/childrens-health-evaluation-care
  • Medicaid Waiver
    There will be a simple transition facilitated by the current ABA services under the Mandate.
  • Traditional Medicaid
    There are a few different types of Medicaid plans, but only those who are enrolled in an EPSDT program qualify.

 

  1. Diagnosis: From a qualified provider, using an approved diagnostic tool to assess ASD services, the child must have an Autism diagnosis rendered by:
  • A qualified doctor, clinician, or psychologist appropriately trained on using the required diagnostic tools:

The accepted assessment tools are:

  • Autism Diagnostic Observation Schedule (ADOS)
  • Autism Diagnostic Observation Schedule: Second edition (ADOS-2)
  • Prelinguistic Autism Diagnostic Observation Schedule (PL-ADOS)
  • These are the minimum requirement for Medicaid, however, your provider may have other additional assessment tools they will use in getting the most accurate diagnosis.
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