Argumentative Essay On Autism

The purpose of this paper is to define autism, define Medicaid, and the role that Medicaid plays in regards to funding necessary therapy treatments for autistic children in the state of Florida. The advantages and disadvantages of Medicaid will be discussed as well as possible intervention points. This topic is of interest to me because I work with this population on a daily basis as an occupational therapy assistant. It is important to be aware of this program and how it affects the autistic population because 1 in 68 children are diagnosed with autism (Chen, Peñagarikano, Belgard, Swarup & Geschwind, 2015). The Medicaid coverage for autistic children is great, although the criteria and acceptance process is a long and tiring one. Autism,

Nearly all Florida Medicaid beneficiaries are now enrolled in managed care plans, like health maintenance organizations (HMOs) (Clemans-Cope, Long, Coughlin, Yemane & Resnick, 2013). To receive federal funding, the state Medicaid programs are required to cover certain populations (low-income children, low-income families and pregnant women) (Clemans-Cope, Long, Coughlin, Yemane & Resnick, 2013). Each state has its own income limits in order to qualify, based on levels given by the federal government. Florida has set below-average limits for the mandatory coverage groups, and since the state has not accepted federal funding to expand Medicaid, the eligibility rules have not changed with implementation of the Affordable Care Act (ACA) (Clemans-Cope, Long, Coughlin, Yemane & Resnick, 2013). Adults who are not elderly and who do not have dependents are not eligible for Medicaid in Florida, no matter how low their income is. An individual can sign up for Medicaid in Florida via state website, paper application, or by

Individuals must have a diagnosis of autism by the age of 8 in order to receive coverage (Semansky, Xie, Lawer & Mandell, 2013). "The federal Medicaid program may reimburse for services to address ASD through a variety of authorities. Services can be reimbursed through section 1905(a) of the Social Security Act, section 1915(i) State Plan Home and Community-Based Services, section 1915(c) Home and Community-Based Services (HCBS) waiver programs, and section 1115 research and demonstration programs" (Mann, 2014). Under the Medicaid state plan, preventive services and therapy services are covered under different section 1905(a) benefit categories. Other Licensed Practitioner services (OLP) are “medical or remedial care or services, other than physicians’ services, provided by licensed practitioners within the scope of practice as defined under State law" (Mann, 2014). The state may cover practitioners who offer services that help the autistic population even if the providers are not covered under other sections of the plan (Mann, 2014). Therapy services including physical therapy, occupational therapy and services for individuals with speech, hearing and language disorders, may be covered under the Medicaid therapies benefit at 42 CFR 440.110. (Mann, 2014). Physical and occupational therapy must be prescribed by a physician within the scope of his/her practice under state law and provided to the