Children with Autism File Complaint Against State Medicaid Agency to Challenge Denial of Behavioral Health Services
Seattle, WA – April 30, 2012, Washington Autism Alliance & Advocacy(WAA) has sued the Washington Health Care Authority (HCA), the state Medicaid agency, to challenge the state’s refusal to cover medically necessary behavioral health treatments for children with autism. Filed in U.S. District Court in Seattle, the lawsuit claims that HCA is violating federal law by not arranging for medically necessary treatment for children with autism. The children represented in this case have been prescribed and need intensive behavioral treatments commonly referred to as ABA (Applied Behavioral Analysis). ABA is a thoroughly researched and evidence-based standard of treatment for children with autism.
The lawsuit claims that, rather than provide coverage for these needed health care services, HCA delays decisions and forces families of children with autism to jump through unnecessary and repetitive hoops until they become frustrated and ultimately give up hope of getting the treatment the children need. The complaint further alleges that HCA’s practice is to not approve the service or to enroll providers in Medicaid who are capable of providing ABA. The plaintiffs are asking for a declaration that ABA is a covered service and an order that HCA must locate providers and arrange for the therapy to be provided to children with autism, as federal law requires.
Hundreds of affected WAA members cannot afford to pay for the ABA therapy, which typically requires at least 20 hours of therapy per week. According to Arzu Forough, WAA’s spokesperson, “the children we’re representing clearly need timely access to medically necessary treatment that’s been prescribed to them to effectively treat their symptoms of autism and prevent further deterioration of their medical condition.”
The suit was filed by Northwest Justice Project (NJP). NJP attorney Scott Crain noted that “the Medicaid program promises that children with disabilities should receive any medically necessary treatment recommended by their doctor, which for these children includes ABA.”
Reporters who would like more information about the case or WAA or treatment options for children with autism, or to learn more about the families who need Applied Behavior Analysis or providers of those therapies should contact Arzu Forough or Scott Crain. The complaint is filed in United States District Court under cause number 2:12-cv-00742.
From Washington Autism Advocacy