In the 2011 Legislative Session, the Arkansas Legislature passed Act 196, An Act To Provide Health Insurance Coverage for Autism Spectrum Disorders. This law, which took effect in January 2012, requires group health insurance plans to cover services for autism diagnosis and treatment. Your health insurance plan may be affected by this law.
Insurance policies purchased on the Arkansas Health Insurance Marketplace Exchange (created by the Affordable Care Act) and new individual policies sold outside of the exchange are also subject to Act 196 of 2011 and must provide coverage for autism treatment and diagnosis.
There are several different Medicaid programs an individual with autism might be eligible for:
ARKids A/Medicaid – This is full Medicaid coverage provided through SSI (Supplemental Security Income). Eligibility is determined by diagnosis, functional limitations, and income. You can get more information about Arkansas Medicaid HERE.
TEFRA – This is also full Medicaid coverage for children with disabilities but whose parents do not meet SSI income requirements. Eligibility is determined by diagnosis and the CHILD’s income/assets. Families pay a monthly premium based on family income. You can read more about Arkansas TEFRA HERE. TEFRA Medicaid and ARKids A Medicaid cover medically necessary treatment for autism, including applied behavior analysis and other therapies.
Arkansas Autism Partnership/Autism Medicaid Waiver – This Medicaid program is designed to provide early, intensive treatment for children diagnosed with autism. Children must be between the ages of 18 months and five years (must enter the program before their 5th birthday but can continue to receive services up to their 7th birthday). They must also meet the financial and level of care eligibility requirements. This is a statewide program offering one to one intervention in the home for 20 to 30 hours per week. This program is designed to improve the child’s skills in the areas of communication, socialization, self- care and behavior. Parental participation is necessary. For more information contact the AAP staff at 501-301-1100.
Home and Community-Based (HCBS) Medicaid Waiver – HCBS Medicaid Waiver services provide in-home supports to individuals with disabilities so that they may remain in their home rather than residing in an institution. They include such services as family respite, habilitation, and adaptive equipment. You can find more information about HCBS Medicaid Waiver HERE.