CHARLESTON, W.Va. — Later this year, covered treatments for autism spectrum disorder will expand under Medicaid in West Virginia to include applied behavior analysis, but many residents may struggle to find providers for the therapy.
“The reality is we still have a massive provider shortage, so even the kids that have had coverage for a while are still on waiting lists,” said Jill Scarbro-McLaury, director and owner of Bright Futures Learning Services in Putnam County.
She also serves as a board member for the Mountaineer Autism Project which is working on input for the state Department of Health and Human Resources on the draft regulatory changes necessary to extend the Medicaid coverage to applied behavior analysis or ABA.
“It’s intensive, typically one-on-one therapy,” Scarbro-McLaury explained.
“We break down skills into tiny pieces and do intensive work to help you learn how to learn and then you’re able to go into public schools with more skills and much better off than you would have been before.”
Currently, Medicaid covers speech therapy, occupational therapy and other traditional autism treatment services.
A 2011 state law opening up access to ABA specifically excluded such therapy under Medicaid.
Within the next month, Scarbro-McLaury said a proposal to change that will be put out for public comment through DHHR.
“It’s a huge change in terms of making sure that families with Medicaid who are in greatest need also have access to highly trained professionals to get what is gold standard treatment for autism,” she said.
Following an internal review of information gathered, the Medicaid addition is scheduled to be implemented later this year potentially opening up ABA therapy to an estimated 3,000 children in West Virginia in places where providers can be found.
“We want to be completely honest with families and go, ‘This is great. It is not going to mean that suddenly all the kids with Medicaid are actually going to get the service,'” Scarbro-McLaury told MetroNews.
Even in West Virginia’s most populated areas, she said wait lists for ABA are long.
“Everybody has to be patient and realize this a long-term process, but this is one huge barrier that we’ve just taken down.”
ABA is most effective, Scarbro-McLaury said, early on — preferably starting at ages two or three.
“Those kids, 90 percent of the time, make significant progress,” she said.
“Fifty percent of them make enough gains that they’re able to transition into typical kindergarten classrooms without really much additional support and then a remaining 40 percent of the kids make substantial gains and are much better of than they would have been without that therapy.”
Currently, about one in every 59 children in the United States lives with autism spectrum disorder, according to new analysis the Centers for Disease Control and Prevention released last week.
The previous estimate from 2016 indicated one in 68 kids had autism.