Diagnosis rates of autism among children have more than tripled over the past 15 years. One reason, which Minnesota’s welfare scandal lays bare with shocking details, is Medicaid fraud and abuse.
Medicaid pays healthcare providers big bucks to diagnose and treat children with autism—sometimes tens of thousands of dollars a month for a single child. Yet states rarely verify that kids who are diagnosed actually meet the medical criteria for the disorder or that they get appropriate treatment from qualified specialists.
The result: Children covered by Medicaid or the government-run Children’s Health Insurance Program are 2.5 times as likely as those with private coverage to be diagnosed with autism. Many lower-income kids are labeled autistic merely because they have behavioral or developmental problems.
In 2014 the Centers for Medicare and Medicaid Services began requiring state Medicaid programs to cover autism therapy such as applied behavior analysis or ABA, a technique that uses positive reinforcement to improve social and communication skills. ObamaCare plans are also required to cover such therapy as an “essential benefit.”
Previously, the responsibility for providing such treatment fell mainly on public schools. Many lacked the expertise and were happy to shift the costs to federal taxpayers, which cover between 50% and 75% of Medicaid bills for most beneficiaries.