Florida Appeals Court Rules Medicaid Agency Must Cover Applied Behavioral Analysis (ABA) Therapy When Medically Necessary for Children with Autism

On September 20, a federal appeals court upheld an order directing Florida to cover applied behavior analysis (ABA) under its Medicaid program, rejecting claims the therapy is “experimental.” The case was brought on behalf of three children diagnosed with autism against the Florida Agency for Health Care Administration (AHCA), which administers the state’s Medicaid program. The plaintiffs had sued the state in 2011, contesting its blanket denial of ABA coverage. “This case will have national impact because, while most states mandate that private insurance companies must cover ABA, most Medicaid programs do not provide coverage,” said Miriam Harmatz of Florida Legal Services, lead counsel for the plaintiffs. The appeals court, however, did remand the case to clarify that AHCA retains the authority to determine the medical necessity for ABA coverage on a case-by-case basis. Read more at governing.com.