A federal appeals court has upheld a ruling that impoverished Florida children with autism cannot be denied a costly but proven treatment that can help them lead more productive lives.
The 11th U.S. Circuit Court of Appeal in Atlanta has ruled that U.S. District Judge Joan Lenard of Miami was justified when she ordered the state Agency for Health Care Administration to pay for the treatment. Lenard’s ruling could affect thousands of Florida children who have the often-debilitating neurological disorder, enabling them to receive what is called applied behavior analysis, an intensive treatment that can help autistic children speak and function at a higher level.
The lawsuit was filed by Legal Services of Greater Miami on behalf of three autistic children in the Miami area who were denied access to behavior analysis by Medicaid, Florida’s insurance program for poor and disabled people. Medicaid called the treatment, often called ABA, “experimental,” and therefore not medically necessary for a child’s treatment. But following a lengthy trial, Lenard ruled the therapy had long been regarded as safe and effective by mainstream doctors, and that the state was discriminating against poor children by denying it. In Florida, like many states, private insurers are required to cover behavior analysis.
“This case will have national impact, because, while most states mandate that private insurance companies must cover ABA, most Medicaid programs do not provide coverage,” said Miriam Harmatz, lead counsel on the case.
Carol Marbin Miller