Vermont families of children with autism worry that life-changing services their children receive won’t be covered by the state’s insurance in the new year. In November, the Department of Vermont Health Access announced changes to Applied Behavior Analysis (ABA) coverage, saying it is being forced to make changes to comply with state and federal guidelines and best clinical practices.
Proposed Changes and Their Impact
The announced changes include taking away certain telehealth services beneficial for rural families, removing a licensed assistant behavior analysis as a healthcare provider, limiting the number of people a program can help, and removing concurrent billing on ABA services. Currently, with ABA services, a clinician works directly with a child every day with their approved program, and someone else monitors the program and makes adjustments as necessary. The Department of Vermont Health Access argues this concurrent arrangement means Medicaid pays for two people, when it should only pay for one service. “So this is to fix that and ensure that providers are not billing twice when we should be only paying for that service once,” said Alex McCracken, the communications director for the Department of Vermont Health Access.
Provider and Family Concerns
Service providers and families receiving ABA worry this will have massive impact on care. One parent shared that her son was nonverbal before starting ABA at Bounce Preschool. “Within six weeks of starting there, he started speaking. Which he hadn’t done before that, which is huge, right? And since that, he’s made steady gains.” Service providers believe both the direct clinician and monitoring services are necessary. According to advocates, removing concurrent billing “opens the door for ineffective or possibly harmful services to be provided.” Proposed changes occur “behind closed doors without engaging with any of us who they’ve engaged with for years,” according to Brian Marrier with Autism Advocacy Intervention. The Department of Vermont Health Access asserts that “it is DVHA’s goal to preserve the ABA benefit for Medicaid members, and these changes are intended to do that.” Public comment was accepted until December 25, with changes set to take effect January 1.
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://www.wcax.com/2025/12/22/vt-families-worry-medicaid-changes-will-cut-autism-therapy-coverage/