Individuals with autism may be eligible for services funded through local or state governments. If you’re wondering how to access Medicaid for autism in North Carolina, this article is here to help.
What is Early Periodic Screening, Diagnostic, and Treatment?
Early and Periodic Screening, Diagnostic and Treatment or EPSDT is a child healthcare program in Medicaid. It helps the developmental, physical, and mental health needs of individuals under the age of 21. The goal is to find any illnesses or disorders early and provide medical and behavioral interventions in order to give individuals the best skills needed to transition into adulthood. In order to quality for EPSDT services, children must be on Medicaid. Medicaid is a federal and state program that helps with medical costs for some people with limited income and resources.
What is Covered in the EPSDT Screening?
EPSDT covers screening and diagnostic tests for conditions as well as any medically necessary intervention. These tests and interventions include comprehensive diagnostic evaluations, preventative screenings, delivery of research-based intensive behavioral health treatments, and behavioral assessment, and the development of a treatment plan.
How Do Families Access Medicaid for Autism in North Carolina?
To find out if you or your child are eligible for Medicaid, apply online or through your local Department of Social Services. Though Medicaid is income-dependent, children receiving SSI/SSDI could be eligible based on their disability or disorder. Children under 21 who are eligible for Innovations waiver or B3 services are eligible for EPSDT services. Requests for autism behavioral interventions must be made by a physician. Requests for children ages 3 to 21 should be made to the local LME/MCO.
What To Do If You’re Having Problems Accessing Medicaid for Autism
If the LME/MCO staff tell you that they are not aware of EPSDT services or that you are not able to get EPSDT services, ask to speak with staff who has expertise in intellectual or developmental disabilities and/or with autism. If you are told you cannot get EPSDT services over the phone, inquire about the reasons that your child under 21 does not qualify and call The NC Department of Health and Human Services Customer Service line at 800-662-7030.
If you get an official written denial of EPSDT services, it can be appealed online here.
About ShineLight | Information on Medicaid for Autism in North Carolina
ShineLight is a unique organization created with the wellness purpose of providing a brighter life and future for individuals with autism. ShineLight serves as a guiding light for individuals and their families by leading the way in support services and community education and advocacy. Their service areas include: Fayetteville, Wake, Sampson, Scotland, Duplin, Wayne, Lenoir, Greene, Wilson, Edgecombe, Durham, Johnston, Cumberland, Hoke, Robeson, and Bladen Counties. Contact us today.
