2014 Utah Autism Insurance Reform Bill Introduced

SALT LAKE CITY (February 6, 2014) -- Autism Speaks today formally endorsed SB.57, the latest piece of legislation to require certain health plans in Utah, the state with the highest prevalence of autism in the nation, to cover medically necessary treatments.

Utah is one of just 16 remaining states yet to enact autism insurance reform, having instead created a "lottery" under its Medicaid program in which several hundred of the state's estimated 18,000 children with autism are randomly chosen for treatment. The 2014 bill is again sponsored by Dr. Brian Shiozawa, a Salt Lake Republican Senator and past president of the Utah Medical Association.

SB.57 would require state-regulated health plans to cover applied behavior analysis (ABA) up to $36,000 a year for children through age 8, then up to $18,000 a year though age 17. The new bill mirrors a coverage plan Salt Lake Mayor Ben McAdams proposed for county employees in his 2014 budget proposal.

Small businesses with fewer than 50 employees would be exempt from providing the coverage if they could demonstrate it raised the cost of their health plans by 2.5 percent or more. A new study in Missouri showed the impact of its autism insurance reform law during 2013 on total health care costs was 0.2 percent.

“"We commend Senator Shiozawa for his continued leadership for the growing numbers of Utah families raising kids with autism," said Lorri Unumb, Autism Speaks vice president for state government affairs. “"Autism Speaks is proud to join with the Utah Autism Coalition and the entire Utah autism community in calling on the legislature to get the job done this year."

According to a 2012 Centers for Disease Control study, 1 in every 47 Utah children has autism, the highest rate in the nation and significantly higher than the 1 in 88 national average. The University of Utah calculated that between 2002-2008, autism prevalence increased twice as fast in Utah than nationally (157 percent versus 78 percent.)

Utah now runs a program funded through its Medicaid program and voluntary contributions from the private sector that serves several hundred children selected at random. The Utah Autism Coalition has estimated over 18,000 Utah children have autism.

The absence of health coverage has created severe financial hardship for many Utah families, recounted in one case recently by a Murray family forced to sell their home after paying out-of-pocket for one year of ABA therapy. The Salt Lake Tribune has tracked various hardships experienced by Utah parents without insurance coverage for their children with autism, including a report that cited 20 cases of parents surrendering their children to the state because they could not afford to provide them the autism treatments they needed.

Shiozawa's bill would require state-regulated health plans to cover the treatment of autism, including speech, occupational and physical therapy, as well as pharmaceutical benefits.