My child needs an autism evaluation. What should I do?
In Oregon, you will need to get both an educational identification and a medical evaluation for autism spectrum disorder. These are not the same thing, have different costs and requirements, and they open the door to different services.

Why should we consider getting an EDUCATIONAL autism assessment?
To receive educational support and services at school for autism, the child must have an educational identification of autism. A medical diagnosis is not sufficient to qualify a child for educational services. In addition, the evaluators must find that the child’s disability (autism) creates barriers to the child’s ability to access a “free and appropriate public education.”

Education services provided will depend on the child’s needs as determined by an IFSP – Individual Family Support Plan (for ages 5 and under) or IEP – Individual Education Plan (over age 5). For free help in navigating the special education system, please contact FACT Oregon at LINK or call 888-988-3228.

• Under age 3, services are provided at your home.
• After age 3, services may be provided in a special education preschool.
• Once eligible for kindergarten, services are provided at your child’s school.

How do I get an evaluation for an educational identification for my child?
If your child is under age 5 (not yet eligible for kindergarten), contact your local Early Intervention/Early Childhood Special Education Services (EI/ECSE). Here is the link to a brochure that provides information at EI/ECSE and contact information by county: LINK.
(In Spanish: LINK; in Russian: LINK). You want to use the child’s county of primary residence.

If you child is over age 5 by August 31 of that year, contact the child’s local public school even if your child does not attend that school.

As part of the evaluation, the multidisciplinary team will observe, interact, and use other tools or methods to gather information on your child. These procedures will help the team find out how your child functions. The team will then meet with the parents to discuss whether the findings mean that your child is eligible for services

What does it cost?
There is no charge for an educational autism identification.

How long does it take to get an educational evaluation?
Under the Oregon Administrative Rules (OAR 581-015-2110), the evaluation must be completed within 60 school days (that is, days school is in session) once the parent has signed the necessary consent forms. To avoid a lengthy delay over the summer break, try to get the consent forms signed and returned to the school at least 3 months before the end of the school year.

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Why should I consider a MEDICAL evaluation for autism for my child?
A medical diagnosis will allow your child to access medical therapies for autism, including speech/ language therapy, physical therapy, occupational therapy and behavior therapies such as ABA (Applied Behavior Analysis). The exact therapies will depend on your child’s needs. Note: You can access all of these therapies, except ABA, without an autism diagnosis depending on your child’s needs.Talk to your child’s primary care doctor for referrals. 

A medical diagnosis is also needed to be approved for Developmental Disability (DD) Services and SSI. DD Services and SSI also have other eligibility factors so the medical diagnosis is necessary but not sufficient on its own to receive these services.

What can I do to determine if my toddler needs an autism evaluation?
The MCHAT-R is a helpful screening tool to help determine if your toddler-age child needs further assessment by a medical professional for autism. The most user-friendly version that we’ve found is through Autism Speaks at this LINK.

How do we get a medical diagnosis for autism?
To get a medical evaluation for autism spectrum disorder, you will need to get a referral from your child’s primary care provider. The best practice for a medical diagnosis of autism is to have a team with different areas of expertise observe and evaluate your child over the course of a few hours. Because autism is diagnosed only by observation of behavior (and not a blood test or other physical test), it’s very important to have skilled people making the diagnosis.

On our website, we have a Professional Resource Directory, which includes a category for child diagnosis at LINK.  Click on +Medical Providers/Diagnosis, then click on +Children-Diagnosis for listings by county. This is not an exhaustive list but a good starting point. Check with your insurance provider to see which providers they cover.

What is the cost of a medical diagnosis?
Depends on your insurance. Under OHP (“Oregon Health Plan,” which is Oregon’s version of Medicaid), there is no cost. Private insurance in Oregon will cover an autism evaluation, but may have a copay or deductible to be paid. Please note that if you are covered by self-funded insurance, they may or may not cover an autism assessment so please check with your employer.

If your family’s household income is less than 305% of the Federal Poverty Guidelines, your child is eligible for OHP. (For a family of 3, that’s up to a household income of up to $5,282 per month.) Here is a link explaining what OHP covers and the income limits for 2020: LINK.  The income limits for 2021 should be similar but aren’t posted yet.

For more information on OHP and to apply, see LINK. An application for OHP can be made at any time during the year. There aren’t any sign up periods. It should take up to 60 days to approve an OHP application, but check in with them if you don’t hear back.

How long does it take to get a medical diagnosis?
There are wait lists for providers and it can take several months to over a year to get an appointment. This can vary widely depending on the age of the child, which facility you use and how busy the facility is. Older children often have longer waits. If feasible, sign up to be on the clinic’s “Cancellation List.” Being on a cancellation list means that you will be called if there is a cancellation, but by definition you will get very little notice and will need to get to the facility quickly.

As mentioned above, an autism assessment is an hours long evaluation for each child from a variety of specialists. Covid restrictions make it even more difficult. In addition, OHSU-CDRC and PNCC tend to have the longest wait lists as they are the best known facilities. Going to another facility may reduce your wait time.

Does insurance cover medical therapies for autism?
Yes, OHP and all private insurers are required under Oregon law to cover autism therapies based on the medical need of the person although co-pays and deductibles can still apply. The only exception to coverage is for self-insured companies because they are not controlled by state law.

If your insurance is through a self-insured company that does not cover autism therapies, consider lobbying your company to provide the coverage and/or consider purchasing a separate policy for the child on the Oregon health insurance market exchange. Those policies are required to cover autism therapies and it may be cheaper to pay for the policy than to pay out of pocket for autism therapies. In addition, depending on your income, your child may qualify for OHP, or your child may qualify for OHP through a waiver under Developmental Disability Services.

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Can I access any services or supports for my child even without a diagnosis of autism?
It can be a time-consuming process to obtain an autism diagnosis, both medical and educational. No official diagnosis is needed to access support groups offered by the Autism Society of Oregon, and most other groups don’t limit access either. All of ASO’s support and social groups are free, and most other groups are also free or have a minimal fee.

We have a list of all the support and social groups that ASO sponsors which are currently meeting online (by Zoom) at LINK.

We also have a list of support and social groups on the ASO website by region at LINK.  Click on each region for the listings in that area. We list the groups we sponsor first in each region, then list all of the groups we know about in the area. We try to keep the list updated but please check with any group you are interested in because things change quickly.