Lawsuit Challenges Children’s Autism Services in Texas

Therapist works with a little boy

by Andy Jones
January 3, 2017

Disability Rights Texas and Texas RioGrande Legal Aid filed a class-action lawsuit in December against the state of Texas for failing to adequately treat children with autism spectrum disorder in its Medicaid program.

“In other states, children with autism spectrum disorder have sued to get ABA from Medicaid,” said Susan Zinn, lead counsel in the case and a TRLA attorney, news release. “Every time children sue, they win."

The Medicaid Act requires states to cover all “medically necessary” services under its Medicaid program. The Texas Health and Human Services has, in fact, concluded that ABA therapy is the “the most recommended, evidence-based treatment” for children with autism spectrum disorder."

However, the state Medicaid program covers just 30 hours per month of ABA therapy, although autism specialists say that patients normally need a minimum of 20 hours per week of the therapy, according to the San Antonio Current.

Of the estimated 160,000 children with autism spectrum disorder in the state, an estimated four percent are receiving coverage under this limited program.

In addition to the complaint, the advocates filed a preliminary injunction in the U.S. District Court for the Western District of Texas on December 13, which would force the state to temporarily cover ABA therapy while the litigation is pending.

“This is economic injustice that will affect these children for rest of their lives,” said Peter Hofer, co-counsel and an attorney for Disability Rights Texas, in a news release. “And it has broad implications for all the other children who are on Medicaid and have been diagnosed with autism spectrum disorder. That’s why, when other children in these circumstances have sued, invariably they’ve won.”

Disability Rights Washington and Disability Rights Texas are the designated protection and advocacy agencies in Washington and Texas, respectively, and are members of the National Disability Rights Network.