MassHealth and CommonHealth are not subject to ARICA, but consumers should know the following:
- MassHealth covers Applied Behavior Analysis (ABA) therapy for children under age 21 through a special process of prior authorization. Providers should contact MassHealth customer services (1-800-841-2900) to request prior authorization for ABA.
- MassHealth may cover co-pays and deductibles for ARICA mandated treatment, including ABA therapy, covered by private insurance.
- The Premium Assistance Program (a benefit for people with MassHealth), can help with the insurance premiums for employer sponsored insurance policies.
- Premium Assistance can also be obtained for the purchase of unsubsidized qualified health plans from the Connector, for children under age 21. These can only be purchased during the Connector Open Enrollment period, unless there is a documented qualifying event.
- Families covered by MassHealth with children under age 9, can also apply for the Massachusetts Children’s Autism Medicaid Waiver through DDS. This is a limited program with specific application windows. Check with DDS for more information.
- Children under age 21 can access other services for emotional and behavioral issues through the Children’s Behavioral Health Initiative (CBHI) program.
- For a child on MassHealth receiving services through Early Intervention, options to obtain a policy through the Connector should be reviewed well before the child turns 3. Otherwise, ARICA coverage may not be in place when the child graduates from EI, and there could be a wait of up to a year until the next open enrollment opportunity.
If you need any further assistance please contact the Autism Insurance Resource Center.