NY Medicaid For Autism

February 12, 2023

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There are many New York families who have members with autism, and who want to know about Medicaid and autism treatment. In New York, there are a few different options for those on Medicaid to help with autism care—here’s what every family needs to know.

 

What are the NY Medicaid Waivers for Children with Autism?

There are often a lot of questions about Medicaid and what it can and cannot do to help cover the costs of autism care. New York currently has two Medicaid waivers that accept children with autism.

• HCBS 1915(c) waivers
• Waive parent income

Let’s take a look at both waiver options.

 

HCBS 1915( c) Waivers

Home and Community-Based Services (HCBS) are designed to help children, their families, and their caregivers. This waiver will help support children as their work towards their goals and achievements. This waiver offers personal, flexible services designed to meet the mental health, substance use, or developmental needs of each child.

If you have a child with autism, you may be looking into HCBS waivers as part of their care. This waiver applies to children who meet the following requirements:

• Children who need extra care at home or when out in the community
• Children who want to avoid going to the hospital or long-term care facility
• Children who are found eligible for HCBS
• Children who are enrolled or are eligible to enroll in Medicaid

All children eligible for HCBS should contact a Health Home Care Manager through the state in order to get approval for this waiver.

 

Waive Parent Income

Under the Waive Parent Income model, the parent’s income and assets are waived during the financial eligibility process. There are many parents who assume they won’t qualify for Medicaid for their child with autism because of their income, but there actually is a special waiver in New York specifically designed with these situations in mind.

This means if you have a child with autism who needs additional care, the child is considered eligible for Medicaid on their own, even though he or she is living with their parents. The Parent Income Waiver is designed to help lessen the costs associated with providing optimal care for a child with autism.

 

Are Children with Autism Eligible for CDPAP Caregivers in NY?

CDPAP, or Consumer Directed Personal Assistance Program, is a New York-based Medicaid program available for individuals with autism. This program was established to help chronically ill or disabled individuals who need help with daily living activities. This particular program covers older individuals who need care but who no longer would require for programs designed for adolescents.

There are many families who aren’t currently aware that they can get reimbursed to care for a child with disabilities, including those with autism. This program assists a patient with activities of daily living, including:

• Meal preparation
• Personal hygiene
• Light housework
• Transportation 

A parent can qualify as a full-time paid CDPAP caregiver for a child with disabilities, but only if the child is 21 and older. Parents of children younger than 21 are not allowed to act as CDPAP caregivers. They are legally responsible for the child and as such can’t be caregivers under the CDPAP program. However, once the child would no longer be the parent’s legal responsibility, parents, or other family members can apply to be part of this program.

The program has a number of benefits for those who need companionship or who can’t care for themselves. The CDPAP also has other benefits compared to traditional home care health services, including the following:

• Beneficiaries can choose their own caregiver.
• Caregivers don’t need any special certifications or licensing.
• Patients’ loved ones are able to provide care and be paid for providing care.
• Beneficiaries are able to receive better care at home and need fewer hospital visits under care of a friend or family member.
• The service is free for beneficiaries as part of Medicaid.

If you have an older child who needs ongoing care, the CDPAP program may be a valuable option worth pursuing. It helps make the cost of care more manageable and helps compensate families who need to take time off of work in order to care for their loved ones, taking some of the pressure off of families who need to care for adults with autism who are not independent.

 

Does Medicaid Cover ABA Therapy?

One of the biggest questions that parents of children with autism have is whether or not Medicaid covers ABA therapy. Simply put, yes, Medicaid will cover this type of therapy.

ABA therapy has become one of the most prevalent and important treatments available for individuals with autism. This form of therapy helps kids with autism learn skills and lessen problematic behavior including harming themselves. ABA therapy teaches them more valuable ways to handle some of these behavioral challenges.

There are several forms of ABA therapy out there, each catering to different forms of autism. This type of therapy can improve social skills, and language abilities and help with communication. The Medicaid insurance mandate covers the diagnosis, and treatment of autism, including this type of ABA therapy.

 

What is Included in Treatment?

Medicaid has come a long way when it comes to coverage of different autism treatments. In addition to ABA therapy, the following services for individuals with autism are covered as part of Medicaid:

• Assistive communication devices
• Medical care
• Pharmacy care
•  Therapeutic Care (including physical therapy and occupational therapy)
• Speech Therapy

The goal of these Medicaid programs is to help make sure that every family who has an individual with autism is able to access the additional care and services necessary to keep these individuals well-cared for and thriving. With more information on what these programs cover, you can make more informed choices about your family’s autism care needs.

 

If you are ready to work with the best ABA therapy provider in New York, give us a call at (732) 402-0297. Our dedicated team is ready to help and we will treat you like family