Autism and Insurance Coverage in the United States – Updates

CC BY-SA by TipsTimes

CC BY-SA by TipsTimes

Several states took steps towards mandating insurance coverage for autism therapies. Here are the latest updates:


Governor Sam Brownback signed a bill requiring companies with over 51 employees to provide insurance coverage for children under 12 years of age starting next year. Other health plans will be required to offer coverage in 2016. It is estimated that this will cover about 250 children next year, and another 500 the following year, out of the estimated 8,400 who need it.

Rep. John Rubin, a Shawnee Republican who supported the bill, is hoping that autism treatment will be designated as an essential benefit under the federal health care law in 2015, which would allow the state to expand its coverage mandate.


The House Ways and Means Committee opened a poll on bill H 3777 which would encourage teachers to develop teaching plans to include children with autism in regular classroom settings. The legislation would require the Department of Elementary and Secondary Education to develop a training program to help teachers to provide individualized instruction to students with autism in the regular classroom.

The bill also expands the IQ-based eligibility requirement for adult services through the Department of Developmental Services, and allows families to open tax-free savings accounts for families to plan for the care of a child with intellectual disabilities.


State senators voted to advance legislation of Legislative Bill 254, which mandates insurance coverage of intensive autism therapy. The bill also provides financial aid for families who need to purchase specialized formula to feed children with digestive disorders.The bill caps coverage of Applied Behavioral Analysis at 25 hours per week up to age 21. Plans sold through the new health insurance exchanges and some other individual and small group plans are exempt from the mandate.


Legislation that would require insurance companies to cover therapies for young children with autism passed the Senate, but stalled in the House. Opponents of the bill cited concerns for small business owners, who they claim would be unjustly burdened by the mandate. Lawmakers did approve a state budget that included funding to provide autism treatment through the State Health Benefit Plan.

State Senator Renee Unterman will continue to fight for the bill, saying that early coverage will save taxpayers money in the long run by increasing the number of individuals with autism who will be able to contribute economically as adults. She says, “The board of education and the taxpayers, that’s where the burden is, and if you give them that early intervention just like with the other disease processes, it’s much cheaper. And not only is it cheaper, it’s much more compassionate to give them a better quality of life at an earlier stage.”

Intense Applied Behavioral Analysis can cost between $40,000 – $60,000 per year, forcing many families raising children with autism into bankruptcy. Experts recommend 30-40 hours of therapy per week. Studies show that intense early intervention can lead to better outcomes into adulthood.