Hawaii senators debate initiative to cover autism spectrum disorder services through Medicaid


Hannah Saunders


The Hawaii Senate’s Health and Human Services Committee heard testimony on Senate Concurrent Resolution (SCR) 119 on March 24th. The bill would require Medicaid coverage of applied behavioral analysis (ABA) to adults diagnosed with Autism Spectrum Disorder (ASD). 

The bill would require the state’s Department of Health (DOH) and Department of Human Services to both review and research ABA for adults. The departments would be responsible for developing and adopting rules and policies so that the state Medicaid program covers medically necessary services for those 21 and older with neurodevelopmental disorders. The departments would also have to apply for necessary approvals from CMS to amend the state’s Medicaid plan to include reimbursements, including ABA for people over the age of 21 diagnosed with ASD.

Although the committee deferred the resolution to be heard again at a later date, many who provided written testimony are in support of this measure. 

DOH, however, provided written testimony in opposition to SCR 119.

“In terms of covering ABA services for adults, based on our review of the literature, there is a lack of evidence to provide strong practice recommendations that ABA services are effective in treating the population of adults with neurodevelopmental disorders, including ASD,” stated the DOH. 

The department said that recommendations for ABA therapy in adults have been considered on a case-by-case basis, and that medically necessary services for those under 21 years, including ABA, are already provided through the Periodic Screening, Diagnostic, and Treatment benefit under Medicaid plans. The department also mentioned how ABA is most effective for younger children with ASD, based on a body of research.

“Until it is shown that ABA in adults meets the standard of medical necessity and clinical practice guidelines are found to be safe and proven effective, the DOH believes it is premature to develop rules that ensure coverage of this service for adults,” stated the DOH.

The Hawaii Association for Behavioral Analysis (HABA), which works on legislative policy issues impacting the community, also provided written testimony, but in support of SCR 119. HABA cited New Mexico, which adopted a related state plan amendment to remove age limits on Medicaid-covered ABA services related to ASD, as well as a state plan amendment that was approved by CMS. 

“HABA supports creating access to medically necessary services across the lifespan,” stated HABA. “The bill would ensure that individuals aged 21 and over would be able to access medically necessary services. Further, this bill would create parity for QUEST (Hawaii Medicaid) beneficiaries, as those with private insurance are already covered across the lifespan.”