News
SCDHHS Updates Policy on Autism Services
August 27, 2025
There are new South Carolina Healthy Connections Medicaid rules starting September 1, 2025. They allow primary care doctors to perform a Medical Care Home Autism Assessment. This allows eligibility for services for 18-36-month-olds who are at risk for autism before a full assessment is made.
What Else is New for Autism Evaluations in SC Medicaid
Presumptive Eligibility: Children aged 18-36 months identified as “at-risk” through a doctor can start services immediately while awaiting the full CDA.
CDA is Now the Official Term: The Comprehensive Psychological Evaluation is now called the Comprehensive Diagnostic Assessment (CDA).
Qualified Providers for CDA: The CDA must be performed by a licensed psychologist, a licensed psychoeducational specialist (LPES), or a developmental pediatrician.
How to Get an Autism Diagnosis for Medicaid Services
Services: Once a diagnosis is confirmed by the CDA and the criteria for medical necessity are met, the child can receive covered autism services.
Screening: Speak with your child’s pediatrician or primary care provider about your concerns. They can perform developmental screening to check for potential risk factors for autism.
Medical Care Home Autism Assessment: If the screening shows potential risk, a primary care doctor may be able to complete this assessment.
Comprehensive Diagnostic Assessment (CDA): If further assessment is needed or the family is not in the 18-36 month age range, a referral to a specialist for the CDA will be made.
What families need to know
- If your child already has an autism diagnosis, the new rules do not change their current services.
- For new evaluations, talk to your child’s pediatrician to see if they are able to offer the new Medical Care Home Autism Assessment.
Find a list of qualified providers on the SCDHHS website