Barriers to ABA Therapy in Michigan (and How to Overcome Them)

Diagnosis

It’s important to consider that the statistics quoted above are based upon people who have had opportunities to be formally diagnosed. Access to professional diagnostic testing is one of the foremost barriers to obtaining ABA services in Western Michigan right now, as insurance providers require a diagnosis in order to approve coverage. Clinicians who are qualified to diagnose autism are simply in such high demand that they often have waitlists that are months, and sometimes even up to a year, long. Based on the Lakeshore Regional Entity’s internal data, for clients with Medicaid in Western Michigan, the current average wait time from a physician providing a referral for diagnosis to the client beginning ABA services is 222 days.

As I just touched upon, the first step in receiving a diagnosis is to get a referral from a physician. While pediatricians and nurses can be qualified to diagnose autism, many do not have formal training to do so and need to make referrals to another professional – typically a Licensed Professional Counselor (LPC). That credential, though, requires ten years of experience and a PhD to obtain. While Limited Licensed Professional Counselors (LLPCs) with master’s degrees can also conduct diagnostic assessments, they must do so under the supervision of an LPC. You can see why such a professional would be in high demand! And that demand is even greater now due to the ongoing pandemic, where the number of people seeking mental health services has increased, which in turn has led to a nationwide shortage of available psychologists.

Another concern might be whether your physician has the experience or not to recognize signs of autism and provide a referral in the first place. If you believe it would help to advocate for a referral for yourself or a family member, one option is to complete an independent screening at home using a tool like the Modified Checklist for Autism in Toddlers or the Camouflaging Autistic Traits Questionnaire for adults. Just be sure to note that these tools do no diagnose autism in and of themselves; they merely suggest if further assessment could be warranted.

At Waypoints, we are working to be able to provide diagnostic assessments directly through our company to help streamline access to services.

ABA in Schools

However, there are other options that do not necessarily require formal diagnosis! In public schools, all students are entitled to a free and appropriate education (FAPE) due to the Individuals with Disabilities Education Act (IDEA). Depending on assessment results and the agreed-upon individualized education program (IEP), this may include ABA services as part of the school day. While we currently offer primarily in-home services, Waypoints clinicians and technicians are absolutely available to work with clients in school (and other!) settings as well.

The Michigan Department of Education provides a helpful fact sheet which includes guidelines for how to advocate for a student’s needs if they are not yet being met, and this informational website reviews the full process of developing an IEP! In Michigan, adult learners up to the age of 26 are also covered and may still receive access to special education funding.

Michigan provides a variety of helpful free support services in schools. The Early On program covers children from birth to age 3, Build Up Michigan extends through age 5, and there is a comprehensive guide to local school districts available at this link. A variety of other caregiver resources are provided by the Michigan state government here at michigan.gov.

Insurance

While it is an option to pay for services out of pocket, thankfully ABA is covered by most insurance providers. Insurance coverage of autistic children has improved over the years, with 64% covered in 2020 vs. 36% in 2016. At Waypoints, we are currently contracted with Medicaid, Priority Health, and Blue Cross Blue Shield.

Coverage of behavioral health treatment is available through Medicaid as part of the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) benefit. A primary care physician can conduct a screening for autism spectrum disorder (ASD) and refer anyone under the age of 21 for services, after which a more comprehensive diagnostic evaluation must take place in order to confirm the necessity of support services. At that point, the referral is sent out to potential service providers that can meet the individual’s needs, like Waypoints!

If you and your family don’t qualify for Medicaid for any reason, another option is the Healthy Michigan Plan. This program is restricted to families with financial need, but it is definitely worth applying to see if you are eligible.

Regardless of your insurance provider, you can contact your doctor’s office or local Community Mental Health Service Program (CMHSP) for next steps with regard to pursuing ABA services. The Michigan Autism Council even provides a step-by-step guide for talking to insurance representatives!