by IABA Team | Feb 26, 2022
A Licensed Practitioner of the Healing Arts (LPHA) in Illinois can be legally defined in several ways. The important definitions for the sake of this blog will be listed, as some definitions are not applicable to autism or ABA therapy services.
- A clinical psychologist who holds a valid license in the state of practice and is legally authorized under state law or rule to practice as a clinical psychologist, so long as that practice is not in conflict with the Clinical Psychologist Licensing Act
- A licensed clinical professional counselor possessing a master’s degree who holds a valid license in the state of practice and is legally authorized under state law or rule to practice as a licensed clinical professional counselor, so long as that practice is not in conflict with the Professional Counselor and Clinical Professional Counselor Licensing Act [225 ILCS 107]
- A clinical social worker possessing a master’s or doctoral degree who holds a valid license in the state of practice and is legally authorized under state law or rule to practice as a social worker, so long as that practice is not in conflict with the Clinical Social Work and Social Work Practice Act.
LPHAs & ABA Therapy
LPHAs are important when it comes to ABA therapy service providers and Medicaid. Many service providers are nationally licensed for Medicaid, with state licensure being an afterthought. If a provider is nationally certified by Medicaid but not certified at the state level, they need to be supervised by an LPHA.
Medicaid treatment plans using ABA therapy and services must be supervised by an LPHA for billing. An LPHA will supervise programs, time, & service professionals and how Medicaid should be billed.
LPHAs are not required to have contact with clients–they simply manage billing and other backend processes. If a billing conflict arises, LPHAs will contact service providers in order to figure out what is going on with a certain expense.
ABA Therapy from IABA Consultants
IABA consultants is now accepting All Kids Medicaid!
Medicaid Clinic Timeline:
- Oak Lawn: Current
- Naperville: May 2022
- Glenview: Summer 2022
- Managed Care Plans: Summer 2022
Dates are tentative and may be subject to change.
For details and coverage information, find the location closest to you and give us a call or send us an email.
If you have questions regarding autism treatment, education, or plans to use 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.
by IABA Team | Feb 19, 2022
Medicaid in Illinois has 2 types of plans that are commonly given to children–All Kids and Managed Care plans. The short version of what these 2 packages are can be summed up by saying All Kids is a complete health insurance plan while Managed Care is a recommended care plan where some things may not be covered.
Both of these plans have specific uses for those in need of healthcare. Applications need to be submitted and approved before any coverage is granted.
So, what are the differences between All Kids and Managed Care when it comes to benefits and uses? Let’s take a look.
Illinois Medicaid All Kids
All Kids is, quite simply, a complete health insurance package for a child in need.
Illinois’ All Kids program is for children who need comprehensive, affordable, health insurance, regardless of immigration status or health condition. All Kids covers:
- Doctor visits
- Hospital stays
- Prescription drugs
- Vision care & glasses
- Dental care
- Regular check-ups
- Immunization shots
- Medical therapy
- Speech therapy
- Physical therapy
- ABA services (As of October 2020)
To receive All Kids benefits, a family & child must meet several criteria. Check out the Illinois All Kids webpage for more information.
Click here to visit the State of Illinois application page.
Illinois Medicaid Managed Care
Managed care is a kind of health insurance program. When you enroll in managed care, you become a member of a Health Plan. You will have at least 5 Health Plans to choose from depending on where you live. The Health Plan you choose will offer you a full range of services while helping you coordinate your health care.
- Your health care needs
- Help manage your health care conditions
- Give you information you need to stay healthy
- Help you identify your health goals and create a care plan to achieve those goals
- Answer questions about your care
- Find a doctor or specialist
- Transition out of a hospital or facility
- Provide community resources
Unlike All Kids, managed care is not a comprehensive health plan. Managed care plans can help you find the care you need, but may not cover all the costs. Be sure to talk to a Medicaid representative if you have questions.
ABA Therapy from IABA Consultants
IABA consultants is now accepting All Kids Medicaid!
Medicaid Clinic Timeline:
- Oak Lawn: Current
- Naperville: May 2022
- Glenview: Summer 2022
- Managed Care Plans: Summer 2022
Dates are tentative and may be subject to change.
For details and coverage information, find the location closest to you and give us a call or send us an email.
If you have questions regarding autism treatment, education, or plans to use 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.
by IABA Team | Feb 12, 2022
ABA therapy only recently became available as a Medicaid-covered health option in October of 2021. ABA therapy and related services are needed more every year, but can be too expensive for many families. Medicaid coverage can alleviate the financial burden and allow families to get the care they need.
What ABA Services & Programs are Covered by Illinois Medicaid?
The state of Illinois only recently (2021 federal EPSDT mandate) recognized ABA therapy as a valid medical service for ASD and other behavioral issues. Illinois Medicaid can cover the following services:
- Behavioral health services
- Licensed clinical psychologists
- Licensed clinical social workers (LCSW)
- Board-certified behavioral analysts
- Registered behavior technicians
- Specialists in any of the above categories
Clinical psychologists and LCSWs can oversee and evaluate behavioral programs conducted by BCBAs or RBTs. Medicaid funding is required that a state-licensed Licensed Professional of the Healing Arts (like a clinical psychologist and LCSW) supervise BCBA treatment plans for individual plans to cover ABA services. The behavioral programs are created based on individual needs and get input from clients, families, and healthcare professionals. All behavior programs must be formally created using behavioral analyst assessments (like the ABLLS/VB-MAPP) and have measurable goals on their behavioral treatment plan as required by Medicaid.
Finding a Provider for Medicaid ABA Therapy
The biggest hurdle for anyone looking to secure Medicaid-covered ABA services is the lack of providers. ABA therapy is allowed to be covered through Medicaid, but ABA services providers don’t have to accept Medicaid.
The best way to find an ABA service provider that accepts Medicaid is to talk to your child’s doctor or psychologist and ask about clinics or services that accept Medicaid. LCSWs are also a great way to find a provider that accepts Medicaid (LCSW services may be covered under your Medicaid plan).
Medicaid Managed Care for ABA Therapy
Be sure to get information about both the Medicaid All Kids and Managed Care before applying. Managed Care programs are not actually handled by Medicaid–they are handled by contracted insurance providers (In Illinois the providers are Blue Cross Blue Shield IL and Meridian).
While All Kids is directly handled by Illinois Medicaid, Managed Care is handled by contracted outside insurance providers who report to the state. Managed Care programs may make different recommendations based on the insurance provider who manages a given plan. This may happen by recommending children to a specific in-network provider for a given service (in-network for BCBS Community or Meridian).
The coverage varies greatly from All Kids to Managed Care programs, so make sure the services your child needs are covered by any Managed Care program you are considering.
ABA Therapy from IABA Consultants
IABA consultants is now accepting All Kids Medicaid! For details and coverage information, find the location closest to you and give us a call or send us an email.
If you have questions regarding autism treatment, education, or plans to use 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.
by IABA Team | Feb 5, 2022
What is an LCSW?
A licensed clinical social worker (LCSW) is a state-certified social worker with at least a master’s degree in a social work program. Each LCSW must also pass a national examination. LCSWs have extensive professional training in their field (minimum of 2 years & 3,000 clinically-supervised hours after receiving a master’s) and specialize in mental health.
The mental health aspect of social work is what separates an LCSW from other social workers.
How do LCSWs Help with ABA Therapy?
LCSWs work with clients to secure services from the state they are certified in. This includes securing Medicaid coverage for ABA Therapy and related services. LCSWs work doesn’t stop at securing health coverage, however; they also oversee case & client management and evaluate progress.
LCSWs are able to make recommendations and keep an eye on if their recommendations are working as intended. LCSWs are able to do the following in tandem with ABA therapy and services:
- Case Planning & Management
- Implementing and overseeing ongoing cases
- Evaluations of case progress
- Recommendations based on evaluation results
- Social skills groups to support the social goals of ABA therapy
- Supporting the entire family unit with resources and community outreach
LCSWs talk to both the families of clients and the BCBAs (or other certified behavioral health professionals) to create a clear picture of a client’s needs.
LCSWs & Medicaid
Medicaid plans typically cover both social work and mental health services. An LCSW working with Medicaid is able to secure coverage for ABA therapy services. LCSWs are able to make great recommendations due to their mental health expertise, which includes:
- Mental health treatments & programs
- Clinical supervision of ABA treatment plans
- Family & social functions
- Interpersonal relationships
- Systems–both systems theory and first-hand experience
- Family intakes
- Family education (working with families to understand treatment programs)
- Outreach
ABA Therapy from IABA Consultants
IABA consultants is now accepting All Kids Medicaid!
Medicaid Clinic Timeline:
- Oak Lawn: Current
- Naperville: May 2022
- Glenview: Summer 2022
- Managed Care Plans: Summer 2022
Dates are tentative and may be subject to change.
For details and coverage information, find the location closest to you and give us a call or send us an email.
If you have questions regarding autism treatment, education, or plans to use 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.
by IABA Team | Dec 21, 2021
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.
