Current treatments for autism, including Applied Behavior Analysis (ABA), are costly and time-intensive, and there is no guarantee that they will be covered under Obamacare. The federal government declined to institute a national standard for the coverage of autism treatment until 2016, so for now, the decision remains with the individual states. As of October 2013, 34 states had mandates to cover autism treatments, and only 24 applied the same requirement to apply to policies sold under the public exchanges. For a more in depth discussion of the implications for families living with autism see Autism Daily Newscast’s report here.
The Division of Insurance adopted new policies following changes to the Affordable Care Act that eliminated lifetime caps for treatment. Parents have since reported that this change has dramatically reduced the amount of autism therapy covered by insurance companies. Maddie Garrett reporting for KOAA stated that:
‘The Division of Insurance made an emergency regulation that states insurance companies must go back to covering the same amount of autism treatment they did in health plans issued prior to May 2013. It’s meant to bring back up the amount of therapy children were used to getting’
Autism Daily Newscast reported last month that Maine was considering a new bill introduced by Democratic Sen. Colleen Lachowicz of Waterville, that may mean that more children will be able to receive private insurance coverage for autism treatment. At present the current law mandates that insurance companies must provide coverage for treatment of autism spectrum disorder (ASD) only for children ages 5 and under. Any expansion in coverage for the treatment could also be a cost saver for Medicaid as some of those costs would go over onto private insurance.
Currently, Utah uses a “lottery” system that currently provides ABA (Applied Behavior Analysis) to less than 400 families. In the meantime, families like the Griggs, from Murray, Utah, are forced to extreme measures, like selling their home to pay for treatment.
“It’s a decision no family should have to make, ” says Andrea Griggs, mother of Jaxon, 12. “But we’re lucky, really. There are plenty of families who lose everything and still can’t afford treatment for their kids.”
That could change, if Sen. Brian Shiozwa, R-Conttonwood Heights, has his way. His SB57 bill is scheduled for its first public hearing in the Senate Business and Labor Committee. It would require insurance companies to cover the cost of ABA therapy for autism. This is the third time SB57 has been up for review.
“Some lawmakers want to let the [lottery] play out, ” says Shiozwa. We agreed to do that last year and we withdrew my bill. But that can no longer be used as an excuse. The results are in. Here’s an evidence-based therapy that works and we have a vulnerable population that needs help.”
Utah has one of the highest rates of autism in the United States, with 1 in 47 children affected.
In Part 2, Autism Daily Newscast looks at Georgia, Mississippi and South Dakota.