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Advocates press committee to extend MassHealth ABA coverage past age 21
Summary
Family advocates, The Arc of Massachusetts and disability councils urged the committee to expand MassHealth coverage to include applied behavior analysis (ABA) for adults with autism and complex developmental disabilities, citing evidence of effectiveness and inequities between privately insured and MassHealth-covered adults.
BOSTON — Parents, advocates and nonprofit groups urged the Joint Committee on Health Care Financing to extend MassHealth coverage of applied behavior analysis (ABA) to adults with autism and complex developmental disabilities, saying current age limits force a “cliff” of care when recipients turn 21.
Mara Sullivan, CEO of The Arc of Massachusetts, said the bills H1351/S871 (and related measures) would require MassHealth to cover ABA for people over 21 “as private insurance already does.” Sullivan, who identified herself as a parent of two adult sons with profound autism, called ABA “the most effective and evidence-based treatment for people with autism” and said loss of coverage at age 21 leads to regression and increased crisis for many families.
Why advocates pressed the issue: Witnesses described a transition gap when young people age out of pediatric MassHealth ABA coverage at 21. Multiple speakers, including Herb Cabral and family members, said the state’s workforce shortages have worsened transitions and reduced access to day programs that formerly supported adults with autism. Cabral described his son Joe’s multi-year ABA progress and warned that discontinuing services compromises prior investments: “By not funding ABA services over 21, the state is compromising the investment made in individuals prior to 21,” he testified.
Costs and data: Sullivan referenced a 2023 autism commission estimate that 212 people ages 18–20 cost an average of $18,000 a year for services and cited a pilot program that found a 38% reduction in maladaptive behaviors among participants. She and others said further fiscal analysis — including comparing private-insurer spending — would help craft cost-containment options while expanding access.
Committee response: Senators asked about cost estimates and were told by witnesses that existing pilot data and commission reports can inform extrapolations but that comprehensive fiscal figures are not yet available. Witnesses pledged to submit written materials and pilot data to the committee.
Next steps: Advocates asked the committee to report the bills favorably and requested that staff work with MassHealth to develop cost estimates and program designs that could extend ABA where medically necessary beyond age 21.
