ACS or Big Waiver Autism Eligibility

For many Arkansas interested in applying for Medicaid waiver for their child or adult with autism, there's been a lot of confusion about the autism diagnosis.  Is Asperger's covered? How can I build a three-part diagnosis if I didn't orginally go to a UAMS center?

I contacted the Arkansas DHS Developmental Disabilities Service office to get the final word on autism. Here's the response:

I don’t want to tell you wrong, so I looked in my manual. DDS Policy 1035 (Agency Definition of Disability/Eligibility for Services) under Eligibility Criteria states: Diagnosis of developmental disability under definition cited in Arkansas Statute Ann. 20-48-101 and Act 729 of 1993. Is attributable to mental retardation, cerebral palsy, epilepsy or autism. The policy goes on related to Autism and states: “As established by the results of a team evaluation including at least a licensed physician and a licensed psychologist and a licensed Speech Pathologist.”

My handwritten notes from my training on DDS policy indicates that the evaluations can be done separately, but all must concur on the diagnosis and related to the eligible DDS diagnosis of Autism, not Autistic Spectrum Disorders. Individuals with Asperger’s have to meet eligibility based on their level of adaptive function.

Families applying for waiver under an autism diagnosis should thus carefully make sure that all three parts, SLP, doctor, and psychologist, confirm autism and not autism spectrum disorder.  Individuals with Asperger's must go to the second step of adaptive function.

Comments

[ronissa]

even when Ian had the diagnosis of Autism---they made us do the vineland for adaptive

[Eye Contact Arkansas]

Thanks, Ronissa, for pointing out a problem with my story. I will look into your point right away.
This instant feedback from readers is great. If I make any errors, you can tell me what needs to be repaired.

[ronissa]

oh

I am not suggesting you are wrong! I am just saying that we had to do a vineland on Ian---you know how every county seems to be different--sorry that it came across that way and i always love the info you have:)

[Eye Contact Arkansas]

No need to apologize, I would much, much rather hear your confusion about an article. That's the key to good writing and reporting! Something like autism diagnosis for waiver is tricky to discuss and I need all the input I can get from the autism community.

[ann]

I believe under federal IDEA regulations the schools can identify students with autism without a medical diagnosis. The regulations require that the Dr. confirm the child does not have other medically related issues that could be causing the disability.

[Eye Contact Arkansas]

Yes, that's true. In Arkansas I have heard of very few cases of children identified by the schools without a doctor's diagnosis of autism, however.

Medicaid waiver requires its own medical diagnosis criteria that's different from IDEA and education.

[ronissa]

i got a certified letter today saying Ian was denied for the waiver--even though he has a 3 part autism diagnoisis--his vineland was supposedly not low enough--i will appeal

[Eye Contact Arkansas]

The waiver is supposed to be for children who are so disabled that they would be placed in an institution. So while you also need a 3-part diagnosis, their level of functioning is also very important.

Email me, I'll see what I can do.

[ronissa]

thanks--i am going to appeal it--he was 3 points too high--not giving up!