MassHealth struggling with autism services

Costs rising, but rate of reimbursement is not

IN MASSACHUSETTS, families supported by MassHealth are experiencing prolonged wait times to access services for children with autism. The state is currently undertaking a process to adjust reimbursement rates paid for autism services for children and this is an opportunity to leverage expanded access to services for children and provide them with the care they need.

The CDC estimates that 1 in 44 children are diagnosed with autism spectrum disorder. In Massachusetts, the estimated number of children with autism is 16,000. Families face waitlists to see diagnosticians and waitlists to begin therapeutic services. Organizations working to meet the demand for services are experiencing rising costs with no reimbursement adjustments. This results in challenges to recruit and retain qualified professionals to render treatment. In the absence of appropriate adjustment to meet the rising costs for providers, families in need are faced with diminishing quality in services and access to needed care.

Therapy based on the principles of applied behavior analysis (ABA) is well-established as an effective approach to increase the quality of life for individuals with autism. Applied behavior analytic interventions include a long list of empirically supported strategies that increase adaptive behavior and decrease harmful and dangerous behaviors. For instance, ABA therapy can increase effective communication skills for children who are unable to speak. ABA therapy is individualized to meet the needs of each child and their family.

Research suggests that children with autism make the biggest gains when ABA therapy is started early and is intensive.  A quality ABA therapy program requires the oversight of a Board Certified Behavior Analyst (BCBA®) and trained behavior technicians to implement the therapy. But children need access to those services in order to render them effective.

There have been zero increases to the rate of reimbursement since July of 2016 and yet costs have climbed nearly 20 percent in the passing years. Among the escalating expenses for community-based services are hiring and training costs, benefits and health insurance, transportation costs for getting clinicians to the homes of the families they serve. Additionally, these front-line services have had the impact of PPE protection expenses and other safety related expenses in this time of COVID-19.

Providers are struggling to meet the needs of MassHealth families in the communities they serve. This disparity cannot be sustained. These providers not only serve the autism community but are a benefit to the community at large. Community-based providers create thousands of jobs and have a diverse workforce.

Meet the Author

Hanna Rue

Representative / Chief clinical officer, Autism Services 4 Mass Coalition /
It is imperative that the changing landscape be recognized and reimbursement rates adjusted accordingly. Appropriate reimbursement will lead to a number of benefits. With the ability to add more providers, MassHealth members have increased access to services. Additionally, the services they receive will be higher in quality as a result of the providers’ ability to invest in their workforce through training and higher wages to retain quality clinicians.

Hanna Rue is chief clinical officer of and a representative of the Autism Services 4 Mass Coalition.