15:45 PM

Connecting Children with Autism to a Higher Level of Care



Horizon NJ Health will now cover important therapy services for children with autism spectrum disorder, offering their families more coordinated care.

By Vincent M. Visioli, LCSW

Children and young people on the autism spectrum have difficulties with things many people take for granted. Like carrying on a conversation or making a friend or even hearing certain sounds without becoming overwhelmed.

These challenges can make life frustrating for children with autism spectrum disorder (ASD) and their caregivers. Fortunately, more help has arrived for families in New Jersey who qualify for Medicaid.

Beginning April 1, Horizon NJ Health members are now covered for all medically necessary Applied Behavior Analysis (ABA) services for children diagnosed with ASD. ABA therapy can help these children increase their language and communication skills and improve attention, focus, social skills and memory.

While families who use Medicaid qualified for these services in the past, their therapy is now being coordinated by managed care organizations like Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ), which runs Horizon NJ Health. The state chose these organizations to be in charge of ABA services to improve the depth and breadth of care for these families.

Horizon BCBSNJ, for example, has years of experience managing ABA services for companies and individuals who purchase their own health insurance. Now, Horizon NJ Health members with a child with ASD can leverage Horizon BCBSNJ’s expertise in operations, care coordination and treatment plan development.

In New Jersey, there is a shortage of providers who specialize in diagnosing and treating children with ASD. This is especially troubling considering that New Jersey has one of the highest prevalence rates of autism in the country. That’s where Horizon NJ Health steps in, helping connect members with qualified health care professionals who have the capacity to help their children.

Comprehensive services for children with autism

ABA therapy – which is available to people under age 21 – starts with a comprehensive treatment plan created by a doctor, psychologist, or board-certified behavioral analyst. This treatment plan can include many different types of help such as individual, group or family therapy – all designed to help the children learn and practice useful skills and socially appropriate behaviors.

Because children with ASD need a range of services throughout their youth and into adulthood, Horizon NJ Health also covers:

  • Physical therapy, speech therapy and occupational therapy
  • Sensory integration, which helps people process, organize and interpret information related to touch, movement, smell, taste, vision, and hearing
  • Augmentative and alternative communication (AAC) assessments and devices, which can help replace speech for people who have trouble with spoken or written language.

In addition, the Horizon BCBSNJ autism care management program provides resources and a dedicated team that puts the entire family at the center of care to make sure all family members receive the psychological and social support they need. This team also works with a child’s doctors to help coordinate care among the many providers and support programs that a family may engage in the community.

Of course, the doctors and therapists are in charge of the ABA (and all other medical) services. Horizon BCBSNJ remains committed to offering all of its members the support they need to reach their full potential.