In June 2014, the Centers for Medicare and Medicaid Services (CMS, the federal regulatory agency for these programs) published an excellent brochure on EPSDT and the services it guarantees for those on Medicaid from birth through age 20. While the brochure was intended to provide state Medicaid officials information on the coverage guaranteed under federal regulations, it is fairly easy reading for the lay person. Not only should you read it, but you may find it extremely helpful to share this brochure with the doctors and therapists working with your child. While much has been written about EPSDT over the past fifteen years, this brochure contains the latest interpretations of how federal regulations impact our children.
The National Health Law Program has been writing about EPSDT since at least 2003. Their expertise in the field is so exemplary they wrote the 2014 CMS guide to EPSDT referenced in the paragraph above.
This is an excellent list of Medicaid “waiver” programs in all 50 states. It is designed for the disability community and includes information on qualifying for each state’s waiver programs, and how to get the enrollment process initiated.
CMS also provides a list of state waiver programs. This is a simple to use chart that includes whether particular waivers cover children on the autism spectrum (ASD). This listing only includes programs authorized under Section 1915(c) of the federal Social Security Act, designed to promote in-home and community services for the disability community.
This federally-sponsored brochure details how each state incorporates services for the ASD community into its waiver programs, including behavioral therapy (such as ABA). A 2014 paper written by the National Health Law project deals specifically with EPSDT coverage for children under age 21 with ASD.
In 2010, NPR ran an incredible series on the “new civil right”, detailing families’ struggles to keep their kids with disabilities at home and out of institutions.
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