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Utah Department of Health Banner
Autism Ribbon Utah Medicaid Autism Waiver

Waiver Development

2012 HB 272

2012 HB 184

2010 Autism Report

Waiver Development FAQ

Waiver History


Introduction

During the 2012 Legislative session, an autism services pilot program bill was passed (HB-272). The bill requires services to be provided to children with autism spectrum disorders through three different pilot programs:

  1. A Public Employees Health Plan (PEHP) Pilot – this is a pilot program for a limited number of state employees’ children with autism spectrum disorders;
  2. Autism Treatment Account – the bill amended this previously existing account and appropriated one-time funding for use in a two year pilot program; and
  3. Medicaid Autism Waiver - requires the Utah Department of Health to apply for a new Medicaid waiver program to provide services to children with autism spectrum disorders (ASD.) This discussion will focus on the design Medicaid’s two year, pilot program (the Waiver.)


Waiver Development Process

HB-272 provides definitive policy direction to the Department of Health (Department) on many aspects of the Waiver including:

  • assuring that children in rural and underserved areas of the State are among those who receive services;
  • describing that children ages two through five years old are eligible for services;
  • requiring the children are enrolled through an open enrollment process;
  • and requiring that services provided have “demonstrated effectiveness.”

In October 2013, the Department will be required to report to the Legislature on the outcomes and effectiveness of the pilot waiver program. The bill also has a set funding appropriation which will allow services to be provided to an ongoing average of 200 children throughout the pilot period. The funding appropriation guides the development of a limited service package that balances the need to assure effective treatment outcomes with the ability to serve as many children as possible.

In addition, some preliminary work in developing the Waiver was conducted in 2010 through another piece of legislation, HB-184. This legislation required the Medicaid agency to develop a range of options to serve individuals with autism. The range of options was developed in consultation with key stakeholders with specialized knowledge of autism and reported to the Utah Legislature’s Health and Human Services Interim Committee in the fall of 2010. The development of a Medicaid waiver was one of the recommended options resulting from this study.

While many aspects of the program design will be governed by HB-272 and by federal Medicaid law, there are still many opportunities for Utah to develop aspects of the waiver by collaborating with parents and other stakeholders.



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