ABA Therapy & Medicaid

ABA Therapy & Medicaid

ABA Therapy & Medicaid

ABA therapy is not cheap. Thankfully, many insurance companies provide coverage for the cost of the therapy. But what if you don’t have private insurance?

Applied Behavior Analysis is the only empirically-based therapy for children with autism. As research findings validated this, researchers and parent advocates began the hard work of passing legislation that required insurance carriers to cover ABA services for children with autism. In Illinois, in 2008, the Autism Mandate was passed stating children with autism were entitled to ABA therapy and thus insurance must cover this therapy. However, because this was a state law self-funded plans and national plans (like Medicaid) did not have to follow the law. In 2017, Medicaid passed a federal mandate that state plans provide ABA coverage to children with autism. However, because BCBAs hold a national license, not a state license, Illinois Medicaid pushed back. 

For the past five years, providers and parent advocates have been working with Illinois law to find a way to get ABA coverage on Medicaid. Finally, in October of 2020, the ABA benefit was awarded on Medicaid insurance for children with autism with the requirement that BCBA’s are supervised by clinicians that also hold state licensure. This means that for over 13 years children with autism and Medicaid funding were largely left without access to the only evidence-based treatment. 

While this is great, it can still be very difficult to find a provider who will accept Medicaid for payment due to the lower reimbursement rates of Medicaid insurance and the new supervision requirement of BCBAs..

How Do I Get Medicaid to Cover ABA Therapy & Services?

Your child must be diagnosed with ASD by a certified professional before any steps can be taken. If your child has not been formally diagnosed with ASD, the Medicaid website has resources to get you started.

To get Medicaid coverage on ABA therapy you need to find a service provider who accepts Medicaid. Representatives at Medicaid should be able to give you nearby providers that accept the benefits. You can always call local service providers to see if they accept Medicaid (as their website or database may be missing an update).

As of December 2021, the majority of ABA service providers have not signed up for the Medicaid Program. Make sure to ask any provider you speak to about Medicaid coverage.

What Does Medicaid Cover for ABA Therapy?

Therapy & services provided by an ABA clinic will not differ from Medicaid or private insurance families. ABA providers use the only evidence-based therapy for ASD; the program will be used for all children, Medicaid or not. Programs will be modified based on individual needs.

Medicaid coverage for ABA therapy only covers services provided by Board Certified Behavior Analysts (BCBA) and Registered Behavior Technicians (RBT). Any ABA services provided by or overseen by other professionals will not be covered. Any program covered by Medicaid must be supervised by a licensed clinical psychologist or licensed clinical social worker who will oversee BCBAs and RBTs. All ABA goals must be authorized by Medicaid.

The coverage Medicaid provides for ABA therapy will vary from person to person. Speaking to the billing department at any clinic will help you understand what will be covered on an itemized basis. Medicaid will cover all provider expenses.

More Help With ASD & Medicaid

Recently, many Medicaid programs, both nationally and in-state, have upped the support offered for ASD. ABA therapy was ruled to be included in Medicaid benefits over 5 years ago, but Illinois (and other states) have only recently caught up to Medicaid requirements. Aside from just financial assistance, Medicaid programs are making a concerted effort to have more ASD services widely available.

As Medicaid coverage becomes more comprehensive in regards to provider reimbursement, it will be much easier for families to find the help they need. The program is still young, so the number of providers that accept Medicaid for ABA and other ASD therapies & services should grow quickly over the next few years.

IABA Consultants & Medicaid

Here at IABA, we are working very hard to have everything ready to accept families with Medicaid by March 2022 for Naperville & Oak Lawn and May 2022 for Glenview. We are finishing the enrollment process which will let us bill Medicaid quickly and efficiently.

We have been helping families for almost 10 years now and Medicaid will allow us to help those who might otherwise have no options. We are looking forward to being able to accept any family in need of ASD services regardless of their insurance standing.

Accepting Medicaid strongly supports our mission and core beliefs. Our foundation was built on several principles, one being no child with autism will ever be turned away, regardless of funding source. Being able to accept funding from Medicaid greatly expands our ability to help children from all backgrounds. Every child deserves equal care, no matter their background or funding source.

If you have any questions on getting Medicaid to cover ABA therapy & services, please send us an email. We’d be happy to answer any of your questions or put you in touch with one of our associates who can help meet your needs.

What Does In-Home ABA Therapy Look Like?

What Does In-Home ABA Therapy Look Like?

Many ABA therapy programs take place in-home. The comfortable setting makes in-home treatment more conducive to the needs of some children with ASD. In-home ABA therapy may differ from the therapy held in a clinical setting but what do those differences look like?

Family Involvement

Some children with ASD may require in-home ABA therapy to address issues with family members. This also allows family members to interact and learn how to use some of the ABA methods when treatment is over.

Other at-home issues may also require specific in-home therapy. Learning to properly use or interact with integral appliances, routines, and schedules may require the expertise of an in-home ABA therapist.

ABA Therapy Space

In-home ABA therapy usually requires designated spaces to be used. Each program is different and may use different spaces. All or most of the therapy programs will be conducted in these spaces, so be ready to slightly alter your daily routine if a specific room is off-limits for any amount of time (unless required to be there).

Being comfortable with a space may be beneficial to an ABA treatment program, so be sure to talk to your child’s therapist about therapy spaces. 

In-Home ABA Therapy Scheduling

In-home ABA therapy is usually recommended to be conducted with a schedule that will be used during weekends & holidays. Creating a matching schedule for therapy and non-therapy hours can make transitions easier.

Talking to your child’s therapist can help you make a great schedule your child can follow. Be sure to include times, as moving times around can cause issues. Activities, free time, playtime, errand time, sleep schedules, meal times, and any other important family needs should be factored into both the therapy and regular home schedules.

Parents at Home

ABA therapists are not babysitters and should not be used in that capacity. Having a parent or guardian home is imperative during in-home ABA therapy sessions. If you are unable to be there for a specific time or something unmissable comes up, be sure to have a guardian take your place and not an unrelated babysitter.

Talking to your therapist about needs and duties as a parent can help you understand why you need to be home during therapy and what your role may require. Be sure to take any important notes and schedule any new activities.

ABA Therapy from IABA Consultants

If you have questions regarding autism treatment, education, or plans using ABA therapy, we are here for you! Our goal is to make sure no family is turned away due to financial constraints. Our therapy team would love to talk to you. Find the location closest to you and give us a call. We’re here for you.

What Does ABA Therapy Look Like?

What Does ABA Therapy Look Like?

Applied behavior analysis (ABA) is such a broad ASD therapy approach making it difficult to define what a typical program will look like. The amount of therapy and level of parent involvement varies, often according to the specific needs of the child. 

ABA skills training programs and techniques can require several hours each day. While skills training programs are usually implemented by behavior therapists or teachers, parents are often taught critical skills to help their children transfer what they have learned in therapy to everyday life, especially at home.

ABA skills training programs for young children are often based in the home and require special materials and a dedicated area for working. ABA behavior modification therapy may include 1-2 hours of parent training per week with the parents using strategies they learn in between visits. An ABA therapist may also consult with teachers to help support positive behaviors in the classroom. 

Strong ABA Therapy Programs

Strong ABA programs will all be different, as they should be tailored to the individual needs of each client. That said, all strong programs will also have some similarities on a general level.

Supervision

The program should be designed and monitored by a Board Certified Behavior Analyst (BCBA) or someone with similar credentials. Supervisors should have extensive experience working with children with autism. 

Training

All participants should be fully trained, with supervisors providing support, monitoring, and ongoing training for the duration of the program. 

Programming

The program should be created after a detailed assessment has been conducted and tailored to the child’s specific deficits and skills. Family and learner preferences should be given consideration in determining treatment goals. Generalization tasks should be built into the program to ensure the performance of skills in multiple environments. 

Functional Programming

The goals selected should be beneficial and functional to the individual and increase or enhance his/her quality of life. A mix of behavior analytic therapies should be used so that the child has an opportunity to learn in different ways. 

Data Collection

Data on skill acquisition and behavior reduction should be recorded and analyzed regularly. This data should be reviewed by the supervisor and used to measure the progress of the individual and provide information for program planning. 

Family Training

Family members should be trained in order to teach and reinforce skills. They should be involved in both the planning and review process. 

Who Provides the Actual ABA Services?

The top certification board for an ABA therapist is a Board Certified Behavior Analyst (BCBA) and comes from the Behavior Analyst Certification Board. Further certification can be issued in the form of a BCBA-D, indicating the therapist has a doctoral degree. Another license is the BCABA, which means having an ABA education at the level of a bachelor’s degree.

Some ABA therapists may indicate they have several years of experience but are not BCBAs. Individuals in this position should not be providing services unsupervised. Only board-certified BCBAs should be overseeing programs and implementing therapy methods.

ABA Therapy from IABA Consultants

If you have questions regarding autism treatment, education, or plans using ABA therapy, we are here for you! Our goal is to make sure no family is turned away due to financial constraints. Our therapy team would love to talk to you. Find the location closest to you and give us a call. We’re here for you.

Sources

Autism Speaks

Boundaries on the Home Front

Boundaries on the Home Front

Last week I wrote to you about my own journey in boundary-setting as a business owner and woman. This week I’d like to dive deeper into boundaries and talk to you as both a mama and a clinician about boundaries on the home front.

As a clinician, not only do I have extensive knowledge about early childhood development but one of my areas of expertise is reducing disruptive and dangerous behaviors. I spent the first five years of my career in Applied Behavior Analysis working in early intervention and on crisis cases.

I can see my young self now, rested for the day, walking into a therapy session and teaching things like how to work through a tantrum. I worked with each family on their own values and expectations of their child, observed the needs the child was trying to get through their tantrums, and taught consistent consequences to the family as well as adaptive skills to the child. In the range of adaptive skills I often taught language (use your words), patience, tolerance to hearing ‘no,’ disappointment tolerance, and expression of feelings. Each family and child was unique but the structure of the treatment was similar and based on boundary setting.

Learning Boundary Setting as a Mom

Fast forward about 8 years to when I became a mama and my son Henry became a toddler. Henry was (and is) a strong-willed child. I remember writing in his baby journal “I didn’t know babies came out like you…” because Henry was (and is) so vocal about how he sees things and how he wants things done. As a mama, I tried to also be a BCBA and use the same tried and true treatment structure with Henry. State a boundary, follow through with the boundary, use your words, and teach new skills. Easy right? No. Hard no.

Throughout my journey into motherhood, while I love my boys above all else, I have struggled with both postpartum depression (Henry) and a toxic home environment because of domestic abuse.  Toss in three boys who all have varied needs, wants, desires, and voices and the stress of setting boundaries felt impossible. You see, the thing with setting boundaries is that when you first set them children tend to resist them. Boundaries feel like a “no” to children (often they are) and the “no” feels like something for them to rebel against. As a parent, you have to be ready for the explosion as you set expectations. I’m going to be honest here; I could not weather the explosions so I became a, “yes mama”. Ugh.

Boundaries by Example

A year ago when I left domestic abuse my children & me. We were living in a psychologically frightening environment and I knew, no matter how much I wanted their dad to get help, that I couldn’t stay any longer. I set the boundary that I would not live in an abusive environment and modeled this incredibly important boundary for my children. 

Yet as the last year passed my small children had so much change in their little worlds. While some of my “yes mama” tendencies went away, some remained. Want a new toy? Sure. One more piece of candy? OK. TV time? You got it. This also worked the other way and when my children behaved in ways I didn’t love (not staying in bed, dumping their food on the floor, screaming for things) I would spend time making empty threats (one more time and then…) and eventually give in. While home life was much calmer as a single mama and my children were happy with me, I knew I had to reset, buckle in, and teach boundaries.

You see, without boundaries children don’t know which behaviors are OK and which ones are not. Without boundaries, they don’t learn how to navigate unpleasant emotions and what to do with their unpleasant emotions. They also don’t learn how to behave in social situations and can become impolite, spoiled, and disruptive.

Keep in mind that little children are still children. It’s basically their job to overreact while testing boundaries early on. It’s our job as parents, however, to shape their behaviors in positive ways. Yes of course I want my children to be happy but I also want them to know how to navigate their own inner and outer worlds. Boundaries are the way to teach this.

Maintaining Boundaries

As the fall came so did a new peace in our home. I set some simple boundaries for the boys I knew I could follow through with and continued to teach them how to navigate their emotions. I spent time making sure the values I set were in alignment with my values and that I was ready for tantrums when they came. The boundaries I set were for good listening, respect, kindness, and understanding “no.” 

My children have become calmer overall after the initial, “holy crap” boundary bursts. Boundaries tell them what is OK and what is not so they don’t have to guess or use tantrums to figure a given situation out. When they don’t like the answer they know we can hold space for them to be sad or mad. It’s a win-win. 

Me? I have a ton of compassion for the woman I was in early motherhood and know I was doing the very best I could at the time. I also am incredibly grateful that I’m in a space to apply my clinical skills to mommyhood. One day (and boundary) at a time.

Xoxo,

Jessie 

ABA Therapy Red Flags (Part 2)

ABA Therapy Red Flags (Part 2)

ABA therapy is the only evidence-based ASD therapy, but the treatment only works if it is done with care. Not all ABA service providers are the same. How can you tell if your child’s treatment is being conducted correctly?

There are some red flags you can look for if you feel your child is not progressing or benefitting from ABA therapy. The points we are going to talk about won’t cover everything, but they will cover some of the most easily observable ABA therapy red flags. 

We have split this article into two parts, as we want to mention why these red flags can be harmful and what you can do to notice them. Click here for part 1.

Not Listening

Every parent has concerns about their children. ASD parents usually have more things to be concerned about. If you have voiced specific major concerns to your child’s ABA provider without an acceptable response, you may need to rethink things.

By voicing major concerns we are talking about lack of progress, not sharing enough information, billing too many hours etc. These are things that should be addressed as soon as possible. Smaller concerns may slip through the cracks so you may need to repeat them in order to ensure they are taken seriously.

If all of your concerns go unaddressed by an ABA therapy provider, it may be time to look for a new one.

Only Using a Few ABA Therapy Techniques

Relying on a small pool of ABA therapy treatments and techniques can lead to a poorly developed program. If you notice your child is being treated with the same methods all the time, you may need to look at their overall program.

Some programs may focus on a small number of treatments for a set period of time, so be sure to ask when or if the program will change or progress. Your child’s ABA therapist should have a good answer why certain treatment methods are or aren’t being used.

All children with ASD are different, so be sure not to question a treatment program after a short amount of time. Have a discussion with your ABA provider to learn about the program that was designed for your child.

Templated ABA Therapy Programs

Similar to only using a few aba therapy methods, templated programs can be a major red flag for ABA programs. Every child with ASD is different and requires a different approach tailored to their strengths and needs.

This red flag can be seen relatively early in selecting an ASD treatment program or clinic. If you are presented with a brochure of programs or therapy ‘packages’ mentioned in a consultation, you need to really look at what is being offered.

In order to get the most out of ABA therapy, each child needs a custom-built program. ABA programs built on general needs will not help each child enough to address specific behaviors and needs.

ABA Therapy from IABA Consultants

If you have questions regarding autism treatment, education, or plans using ABA therapy, we are here for you! Our goal is to make sure no family is turned away due to financial constraints. Our therapy team would love to talk to you. Find the location closest to you and give us a call. We’re here for you.