11/12/2025
Sharing for our friends at the South Carolina Department of Health and Human Services.
One in 31 children has autism in the United States, according to the Centers for Disease Control and Prevention (CDC). Early intervention and getting needed care are key to helping these kids have a better quality of life. Yet, accessing autism care in South Carolina can be hard.
To better support efforts to connect our members to this needed care, Healthy Connections Medicaid updated its autism spectrum disorder (ASD) policy. As of Sept. 1, doctors can screen, diagnose and refer their patients to autism services. This includes applied behavior analysis therapy (ABA). Some frequently asked questions are answered below.
I’ve heard my child needs an “ADOS” to diagnose autism. Is this true? No, the Autism Diagnostic Observation Schedule (ADOS) is just one of the tools Medicaid accepts to get an ASD diagnosis.
Can my doctor diagnose autism? Yes. Medicaid will accept an autism diagnosis from your doctor. This is part of the updated medical necessity criteria. Your doctor can also give a referral to ASD services.
Do I need to repeat autism testing if my child already gets autism services through an Individualized Education Plan (IEP) at their school? What if they get autism services through the South Carolina Office of Intellectual and Developmental Disabilities? No. Please do not repeat testing to confirm a diagnosis of autism. Medicaid’s ASD policy accepts screenings that lead to a child getting services through an IEP. More autism testing is not medically needed to get referred for ASD services.
Are telehealth autism screenings valid? No. Autism testing through telehealth can’t be used to get ASD services.
Does my child need to have an autism diagnosis to get therapy? Children ages 18 to 36 months who are at risk for ASD may be able to get ABA therapy while waiting for a diagnosis. The child’s doctor must be confirmed by Medicaid or BabyNet to administer an eligible autism screening tool.
Members should check with their doctor with any questions about autism. This includes getting an autism diagnosis and reviewing past screenings. They should also check with their provider about referrals to ASD services while waiting on an autism confirmation.
