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Judge Rules Medicaid Age Limit for People with Autism Is Discriminatory

State Residents Age 21+ with Autism Can Receive Medicaid Benefits for ABA Therapy

Our very own attorney Tom Blessing recently achieved a significant victory on behalf of his son Connor and other adult Indiana residents with autism. In 2016, Indiana’s Medicaid program began offering benefits for applied behavioral analysis (ABA) therapy until beneficiaries turn 21. But since autism is a lifelong disability, discrimination came into question. The need for ABA continues far after an autistic individual turns 21. After all, other therapies such as physical therapy and speech therapy are covered by Medicaid after a person turns 21, so it didn’t make sense why ABA therapy was not covered.

These are some of the concerns that prompted Tom Blessing and his son’s mother, Victoria Blessing-Wade, to take legal action.

After filing an administrative appeal with the Indiana Family and Social Services Administration and losing, Tom appealed his now 24-year-old son’s case in court. He strongly believed that “This case was different: the age restriction in the Medicaid rule is so clearly arbitrary and blatantly discriminates against people with autism,” which triggered Tom to seek a review of the administrative ruling in state court.

The result? On May 21, 2021, the judge concluded that the age restriction imposed by Indiana Medicaid is unlawful.

The judge backed her decision by asserting there is no evidence suggesting that ABA therapy does not benefit someone with autism after they turn 21. “There is nothing in the record to suggest that ABA therapy is no longer a medically necessary treatment now that Connor is 23 years of age,” wrote the judge. Accordingly, the court concluded that the age restriction unlawfully denies access to medically necessary services for individuals age 21+ who have autism, in violation of the Americans with Disabilities Act.

We are proud of Mr. Blessing for championing the rights of his son and other Indiana residents with autism. This historic achievement will help countless state residents receive much-needed ABA therapy under Medicaid after turning 21.

What Is ABA Therapy?

After learning about this notable achievement, you may be wondering what applied behavioral analysis therapy entails. Why is it so important for individuals with autism?

For starters, individuals with autism face cognitive, behavioral, communication, and social challenges, requiring medication to control their severe anxiety and repetitive and sometimes dangerous behaviors. ABA therapy is one of the only effective non-pharmaceutical treatments available, however, it is expensive. A full-time program of 30 to 40 hours per week is about $75,000 and $100,000 annually.

ABA involves intensive, one-on-one therapy where activities are broken down into discrete tasks and the person receives positive reinforcement for accomplishing such tasks. ABA therapy is proven effective for people with moderate to severe intellectual and communication deficits, giving parents hope that their child would not suffer the side effects or long-term risks of medication.

Unfortunately, since many school districts don’t provide ABA for students, some parents removed their kids from public school so they could obtain full-time ABA treatment for their child under their insurance policies. However, insurance companies would regularly deny claims, forcing parents to choose between paying out of pocket or foregoing ABA therapy altogether.

Luckily, individuals with autism may now obtain Medicaid benefits for ABA therapy even after turning 21 thanks to the diligent efforts of Tom Blessing. We look forward to seeing the far-reaching, positive effects that this recent case ruling will have on our state’s beneficiaries.

If you have questions about how this case may impact you or your loved one, please contact our firm online or at (317) 434-1490!