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Medical Assistance and Insurance health plans cover many services that we provide. In some cases, families may also pay privately for services.
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Medicaid Funding
Securing Medicaid funding for intensive in-home autism treatment requires two critical components. The first step is to apply for Medicaid. The second step is to request a Medicaid "waiver slot" from the State of Wisconsin. Both components are handled by your county autism services coordinator.
If your child is eligible for Medicaid, he or she will receive a Medicaid card which entitles him to a range of medical services, including mental health treatment. However, the Medicaid card does not automatically make your child eligible for intensive in-home autism treatment. Autism treatment services are available through a different Medicaid program called the Children’s Long Term Support (CLTS) waiver, which serves a fixed number of children with autism per year. Even if your child becomes eligible for Medicaid services, he may have to wait until a "slot" becomes available to pay for autism treatment expenses. Please refer to the Wisconsin Department of Health Services at http://dhs.Wisconsin.gov for more information about how to apply for funding.
Insurance Funding
Effective in November 2009, Wisconsin enacted a mandate for health insurance policies to cover certain services for individuals of all ages with autism spectrum disorders. Covered services include intensive autism treatment, which were historically funded only by the state’s Medicaid program. The new law affects many but not all insurance policies, and provides coverage for both intensive (20+ hours per week) and non-intensive (less than 20 hours per week) services.
Insurance plans vary in terms of the services they will cover, deductibles, co-payments, and annual maximum benefits. Autism services are subject to deductibles and co-payments, just like any other medical service, although some insurance plans have different policies about co-payments for intensive autism treatment. To find out if your health insurance plan is included in the autism insurance mandate, and to learn details about your coverage, contact your insurance company or insurance plan administrator. Be sure to ask about the in-network autism service providers for your insurance plan.
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