CONCORD (January 3, 2013) -- An administrative law judge has ruled that a state-funded service agency cannot deny access to ABA by requiring that a family rely on its private insurance to pay the cost.
The case involved a seven-year-old child whose family had purchased health insurance to guard against catastrophic illness. The policy carried annual deductibles of $6,800 per individual and $13,600 for the family. The policy would not begin covering any ABA treatment until the deductible was met.
Ruling against the Regional Center of the East Bay (RCEB), a private, non-profit corporation under contract with the California Department of Developmental Services, Judge David Benjamin said the agency could not use California's autism insurance reform law (SB.946) to require the child's family to pay for ABA treatment through its insurance. The family said it could not afford the monthly costs for the treatment and that the agency should cover the cost until the deductible was met.
Benjamin ruled that California's Lanterman Developmental Disabilities Services Act pre-empted SB.946 by requiring all state-funded agencies to provide necessary care for people with developmental disabilities.
Read the decision here.