ASD evaluation provider who meet Medicaid's requirements

[MrJoe]

I'm trying to find an ASD evaluation provider that meets Medicaid's requirements for North or South Carolina. Does anyone know how to determine if an ASD evaluation provider meets Medicaid's requirements. Thanks!

 

[Judge]

Sadly you now have to first consider just how limited Medicaid will be with the recent legislation signed into law only days ago. If you're talking about an evaluation for yourself, apparently not for either state. At least according to Duck Duck Go's AI response:

"Medicaid in North Carolina covers services related to autism, including evaluations and assessments for children under 21, as long as they are deemed medically necessary. However, specific coverage details can vary, so it's advisable to check with Medicaid or a healthcare provider for the most accurate information."

"Yes, Medicaid in South Carolina covers all medically necessary care for children with autism, including the diagnosis, as part of the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. This includes comprehensive assessments to establish a diagnosis of Autism Spectrum Disorder (ASD)."

 

[MrJoe]

Thanks! It's for me. I need a "Medicaid Approved" clinician to do an evaluation. Otherwise Medicaid wont accept it. I moved back to the states after 16 years in Canada and have no health insurance and can't function due to ASD burnout, GAD and social anxiety

 

[Judge]

Thanks! It's for me. I need a "Medicaid Approved" clinician to do an evaluation. Otherwise Medicaid wont accept it. I moved back to the states after 16 years in Canada and have no health insurance and can't function due to ASD burnout, GAD and social anxiety

Looks like you'll need to relocate, provided you can find a specific state that extends their Medicaid coverages to adults when it comes to autism, apart from many other conditions past recipients still have.

The president's recent bill passed through Congress and signed into law appears rather grim for Medicaid recipients regarding autism.

 

[Neonatal RRT]

More information:

The impact of the "One Big Beautiful Bill" (H.R. 1) on Medicaid benefits for adults with autism (21+):

While the recently passed "One Big Beautiful Bill" (H.R. 1) includes provisions allowing states more flexibility in managing Medicaid and introducing work requirements and more frequent eligibility checks for some recipients, according to WSB-TV, Autism NJ reports that these specific changes might not directly impact funding for individuals with disabilities. However, substantial cuts to the overall Medicaid program could indirectly affect services available for all beneficiaries.
State-specific Medicaid eligibility for adults with autism
Yes, adults with autism aged 21 and older may receive Medicaid benefits in many states, primarily through disability-based eligibility and Home and Community-Based Services (HCBS) waivers.
Here's how this generally works:

1. Eligibility: Adults with autism can qualify for Medicaid by having a recognized disability (often verified via Social Security Disability or medical evaluation) and meeting state-specific income and resource requirements.
2. HCBS Waivers: Once approved for Medicaid, individuals can apply for HCBS waivers. These waivers allow states to provide services in the home or community, rather than in institutional settings, according to Autism Speaks.
3. Services Covered:HCBS waivers can offer a wide range of services for adults with autism, including:
   • Personal care
   • Respite care
   • Behavioral interventions
   • Therapies (speech, occupational, counseling)
   • Supported employment and prevocational services
   • Day habilitation and residential habilitation
   • Case management
   • Home and vehicle modifications

Important considerations

• State Variations: Medicaid eligibility and the specific services covered by HCBS waivers can vary significantly by state. It is crucial to check the specific guidelines in your state.
• Pennsylvania's Adult Autism Waiver: Pennsylvania is unique in offering an autism-specific HCBS waiver for adults aged 21 and older.
• Impact of the new legislation: While the new law might not directly target autism services, the potential for reduced Medicaid funding could lead states to consider cuts to optional programs, including HCBS waivers, says the Autistic Self Advocacy Network. Stricter eligibility checks and work requirements could also create barriers for some adults with autism to maintain their coverage.
• Continued Importance of Advocacy: Given these potential changes, it's more important than ever for individuals with autism and their families to stay informed about their state's Medicaid program and advocate for the services they need.

To learn more: Contact your state's Medicaid agency or relevant disability agencies for specific information about eligibility requirements, covered services, and the application process for adults with autism in your area.

 

[Neonatal RRT]

Medicaid-approved providers for adult autism eligibility evaluations in North and South Carolina
North Carolina
Several providers in North Carolina offer diagnostic evaluations and services for individuals with autism, including adults. These include the UNC TEACCH Autism Program and the Duke Autism Clinic. Cone Health LeBauer Behavioral Medicine in Greensboro also provides evaluations for those over 18 months, which includes adults. The Autism Society of North Carolina (ASNC) can assist individuals in finding diagnostic testing options and connecting them to resources; they can be reached by phone at 1-800-442-2762 (press 3) or through their online form. Starting with your primary care physician for an initial evaluation and potential referral to a specialist is also a general recommendation.
South Carolina
The South Carolina Department of Disabilities and Special Needs (DDSN) Autism Division offers eligibility screening and evaluations for individuals aged 3 and older. A list of autism diagnostic evaluation providers in South Carolina is available online. Examples include Dr. Laurie Dickson Gillespie, Dr. Renee Lake, Medical University of South Carolina (MUSC), Dr. Michelle Peterson, Palmetto Pediatric, Sandhills Pediatrics, and HopeHealth Pediatrics. To qualify for Medicaid ASD services for beneficiaries aged 0-21, a comprehensive psychological assessment/testing from a licensed psychologist, licensed psychoeducational specialist (LPES), or developmental pediatrician is required. The SCDHHS website has a provider search tool to find eligible providers.
Important Notes:

• North Carolina Medicaid covers Research Based – Behavioral Health Treatment (RB-BHT) for individuals over 21 as of July 1, 2021.
• South Carolina Medicaid ASD services require medical necessity and a comprehensive assessment with an established diagnosis.
• It is always recommended to confirm provider eligibility and service coverage directly with the relevant Medicaid agency or the provider before scheduling an evaluation.

This information is intended as a general guide and is subject to change. For the most current and accurate information on Medicaid-approved providers for adult autism eligibility evaluations in North and South Carolina, please consult with the relevant authorities or professionals.

 

[MrJoe]

More information:

The impact of the "One Big Beautiful Bill" (H.R. 1) on Medicaid benefits for adults with autism (21+):

While the recently passed "One Big Beautiful Bill" (H.R. 1) includes provisions allowing states more flexibility in managing Medicaid and introducing work requirements and more frequent eligibility checks for some recipients, according to WSB-TV, Autism NJ reports that these specific changes might not directly impact funding for individuals with disabilities. However, substantial cuts to the overall Medicaid program could indirectly affect services available for all beneficiaries.
State-specific Medicaid eligibility for adults with autism
Yes, adults with autism aged 21 and older may receive Medicaid benefits in many states, primarily through disability-based eligibility and Home and Community-Based Services (HCBS) waivers.
Here's how this generally works:

1. Eligibility: Adults with autism can qualify for Medicaid by having a recognized disability (often verified via Social Security Disability or medical evaluation) and meeting state-specific income and resource requirements.
2. HCBS Waivers: Once approved for Medicaid, individuals can apply for HCBS waivers. These waivers allow states to provide services in the home or community, rather than in institutional settings, according to Autism Speaks.
3. Services Covered:HCBS waivers can offer a wide range of services for adults with autism, including:
   • Personal care
   • Respite care
   • Behavioral interventions
   • Therapies (speech, occupational, counseling)
   • Supported employment and prevocational services
   • Day habilitation and residential habilitation
   • Case management
   • Home and vehicle modifications

Important considerations

• State Variations: Medicaid eligibility and the specific services covered by HCBS waivers can vary significantly by state. It is crucial to check the specific guidelines in your state.
• Pennsylvania's Adult Autism Waiver: Pennsylvania is unique in offering an autism-specific HCBS waiver for adults aged 21 and older.
• Impact of the new legislation: While the new law might not directly target autism services, the potential for reduced Medicaid funding could lead states to consider cuts to optional programs, including HCBS waivers, says the Autistic Self Advocacy Network. Stricter eligibility checks and work requirements could also create barriers for some adults with autism to maintain their coverage.
• Continued Importance of Advocacy: Given these potential changes, it's more important than ever for individuals with autism and their families to stay informed about their state's Medicaid program and advocate for the services they need.

To learn more: Contact your state's Medicaid agency or relevant disability agencies for specific information about eligibility requirements, covered services, and the application process for adults with autism in your area.

Thanks for the information

 

[MrJoe]

Medicaid-approved providers for adult autism eligibility evaluations in North and South Carolina
North Carolina
Several providers in North Carolina offer diagnostic evaluations and services for individuals with autism, including adults. These include the UNC TEACCH Autism Program and the Duke Autism Clinic. Cone Health LeBauer Behavioral Medicine in Greensboro also provides evaluations for those over 18 months, which includes adults. The Autism Society of North Carolina (ASNC) can assist individuals in finding diagnostic testing options and connecting them to resources; they can be reached by phone at 1-800-442-2762 (press 3) or through their online form. Starting with your primary care physician for an initial evaluation and potential referral to a specialist is also a general recommendation.
South Carolina
The South Carolina Department of Disabilities and Special Needs (DDSN) Autism Division offers eligibility screening and evaluations for individuals aged 3 and older. A list of autism diagnostic evaluation providers in South Carolina is available online. Examples include Dr. Laurie Dickson Gillespie, Dr. Renee Lake, Medical University of South Carolina (MUSC), Dr. Michelle Peterson, Palmetto Pediatric, Sandhills Pediatrics, and HopeHealth Pediatrics. To qualify for Medicaid ASD services for beneficiaries aged 0-21, a comprehensive psychological assessment/testing from a licensed psychologist, licensed psychoeducational specialist (LPES), or developmental pediatrician is required. The SCDHHS website has a provider search tool to find eligible providers.
Important Notes:

• North Carolina Medicaid covers Research Based – Behavioral Health Treatment (RB-BHT) for individuals over 21 as of July 1, 2021.
• South Carolina Medicaid ASD services require medical necessity and a comprehensive assessment with an established diagnosis.
• It is always recommended to confirm provider eligibility and service coverage directly with the relevant Medicaid agency or the provider before scheduling an evaluation.

This information is intended as a general guide and is subject to change. For the most current and accurate information on Medicaid-approved providers for adult autism eligibility evaluations in North and South Carolina, please consult with the relevant authorities or professionals.

Thank you for your help!

 

[Ganeks]

Hey! From what I know, the best way is to check directly with your state's Medicaid website or contact their customer service. They usually have a list of approved providers or guidelines on what qualifications the evaluator needs. You can also ask the provider if they accept Medicaid and if their evaluation meets the state's criteria. Sometimes local early intervention programs or your kid’s doctor can recommend providers too.

 

[MrJoe]

Hey! From what I know, the best way is to check directly with your state's Medicaid website or contact their customer service. They usually have a list of approved providers or guidelines on what qualifications the evaluator needs. You can also ask the provider if they accept Medicaid and if their evaluation meets the state's criteria. Sometimes local early intervention programs or your kid’s doctor can recommend providers too.

Ok, thanks for the info!

 

[WhitewaterWoman]

If you have Medicaid already, it sounds like you do, you can find a list of Medicaid providers with google.

Anyone who accepts Medicaid is by definition a Medicaid approved provider.


The HCBS Waivers typically have waiting lists in the thousands. You want to get that going asap if you think you are interested.

But you have to be able to prove the autism before age 18. If you are looking for an assessment now, I would guess you didn’t get one as a child.

 

[Mary Terry]

I'm trying to find an ASD evaluation provider that meets Medicaid's requirements for North or South Carolina. Does anyone know how to determine if an ASD evaluation provider meets Medicaid's requirements. Thanks!

Contact the providers and ask if they meet Medicaid's requirements.