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Autism Benefits Lagging Under Federal Health Care Reform

January 08, 2013

WASHINGTON, DC (January 8, 2013) -- Just half the states have thus far planned to include ABA coverage in their new health care exchanges which open for business next year, an initial analysis by Autism Speaks has found.

"While the picture remains somewhat murky, the unequivocal support needed by families dealing with autism clearly is missing," said Stuart Spielman, Autism Speaks' senior policy advisor and counsel. "We have an autism epidemic. Merely having some form of health insurance available will not address this epidemic."

The analysis was conducted on the "essential health benefits" benchmark plans each state was to submit to the U.S. Department of Health and Human Services (HHS). Autism Speaks reviewed information on the website of the Center for Consumer Information and Insurance Oversight, the part of HHS that wrote the essential health benefit rules, and found that 18 states were including coverage for behavioral health treatments and that coverage was implied by another four states.

In addition, Delaware and Michigan have subsequently added ABA benefits, and Ohio Governor John Kasich in late December announced that his state would include ABA and other autism therapies as part of its essential health benefits package.

"Failing to categorize behavioral health treatment for autism as a mandatory element of the EHB package is not only bad health policy, but bad statutory construction as well," Autism Speaks told HHS in formal comments. Congress clearly stated when it enacted the ACA in 2010 that coverage for behavioral health treatment had to be one of the 10 essential health benefits each state was required to include as part of their new health care exchanges for the small group and individual markets

The 18 states determined to include behavioral health treatment include:

  • Arizona
  • Arkansas
  • California
  • Connecticut
  • Indiana
  • Kentucky
  • Louisiana
  • Maine
  • Massachusetts
  • Missouri
  • Montana
  • Nevada
  • New Hampshire
  • New York
  • Texas
  • Vermont
  • West Virginia
  • Wisconsin

The four states where the coverage may be included, but is unclear, are:

  • Colorado
  • Illinois
  • New Jersey
  • New Mexico

Autism Speaks submitted seven recommendations to HHS in its comments on the essential health benefits packages. One was to clarify or correct the information on the benchmark plans selected by Colorado, Illinois, New Jersey and New Mexico. All four states have enacted autism insurance reform laws requiring insurers to cover autism therapies, including ABA.

Autism Speaks' first recommendation was to require all insurance coverage in the small group and individual markets to cover behavioral health treatment. During 2012, the prevalence of autism was adjusted upwards from 1 in every 110 American children to 1 in 88, including 1 in 54 boys.

The disparities experienced by families raising children with autism was documented in a 2009/10 Survey of Children with Special Health Care Needs. Nearly half (46.5%) of insured families raising a child with autism said their child’s health insurance coverage was inadequate versus a third of families raising children with other special needs. The number of families who said their child’s health condition had caused financial problems was more than double for families with a child on the spectrum (43%) versus those with other special needs (19.6%).

"These data underscore the need for robust and consistent coverage of behavioral health treatment" in every state's essential health benefits package, Autism Speaks told HHS.

Autism Speaks also urged that all plans provide strong preventive and habilitative services for autism. Screening for developmental delays and disabilities should be conducted at 9 months, 18 months and 24 or 30 months; autism-specific screenings should be conducted at 18 months and 24 months.

The full text of Autism Speaks’ comments is available here.