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HB 4739

Human services: medical services; coverage for diagnosis of autism spectrum disorders and treatment of autism spectrum disorders; require. Amends 1939 PA 280 (MCL 400.1 - 400.119b) by adding sec. 109u.

2025-2026 Regular Session Introduced by Kelly Breen and 9 co-sponsors

Michigan Medicaid must cover autism diagnosis and treatment with no age limit, including adults 21+, by mid-2026 (June 30) after state plan amendments and approvals.

bill electronically reproduced 07/15/2025
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Bill Summary · HB 4739

Summary — HB 4739 (added Sec. 109u to 1939 PA 280 / MCL 400.1–400.119b)

Status: Enacted (signed by Governor 05/29/2025); effective date 01/01/2026.

Purpose

Require Michigan’s Medical Assistance Program (Medicaid) to cover diagnosis and treatment for autism spectrum disorders (ASD) without an age limit, and to extend explicit coverage to eligible adults age 21 and older.

Key provisions

  • Adds Section 109u to the Social Welfare Act.
  • Prohibits the Department from imposing an age limit on coverage under the Medical Assistance Program for:
    • Diagnosis of autism spectrum disorders, and
    • Treatment of autism spectrum disorders. (Subsection (1))
  • Requires the Department to provide coverage for eligible individuals age 21 or older for ASD diagnosis and treatment no later than 180 days after the bill’s effective date. If necessary, the Department must submit and obtain a Medicaid state plan amendment and any required federal approvals. (Subsection (2))

Definitions included in the bill

  • “Autism spectrum disorders” is defined by reference to the Diagnostic and Statistical Manual and explicitly lists:
    • Autistic disorder,
    • Asperger’s disorder,
    • Pervasive developmental disorder not otherwise specified (PDD-NOS).
  • “Diagnosis of autism spectrum disorders” includes assessments, evaluations, or tests (including the Autism Diagnostic Observation Schedule) performed by a licensed physician or a licensed psychologist.

Implementation & timeline

  • Effective date: January 1, 2026.
  • Department deadline: Must provide coverage for eligible adults 21+ within 180 days after the effective date (i.e., by approximately June 30, 2026).
  • The Department must apply for and secure any Medicaid state plan amendments and federal approvals as required to implement coverage for adults.

Who is affected

  • Medicaid enrollees in Michigan — particularly adults age 21 and older who need ASD diagnostic services and treatment.
  • Licensed physicians and licensed psychologists who perform ASD diagnostic evaluations.
  • Michigan Department of Health and Human Services (the “department”), which is responsible for implementing coverage and pursuing federal approvals.

Potential impacts

  • Expanded access to diagnostic and treatment services for adults with suspected or diagnosed ASD.
  • Possible increases in Medicaid program utilization and costs; timing depends on federal approval of any state plan amendments.
  • Providers may see increased demand for ASD diagnostic services and treatment for adult patients.

Legislative history (highlights)

  • Introduced: 03/13/2025
  • Passed House and Senate: May 2025
  • Signed by Governor: 05/29/2025
  • Effective: 01/01/2026

(Amends 1939 PA 280 by adding Sec. 109u.)

Compiled from official sources — confirm details with the bill’s official record.

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