Thousands of children with autism now have access to new or enhanced insurance benefits to cover behavioral health treatment and physical, occupational and speech therapies in six states with the start of the new year. Meanwhile, campaigns to deliver or strengthen those same benefits for thousands more children will soon rev up in state legislatures around the nation, including Georgia and North Carolina where state employees gained coverage starting January 1.
Coverage for the diagnosis and treatment of autism became available January 1 in Nebraska and Maryland, and for new policies issued in Oregon and Washington. Expanded benefits took effect in Kansas and Maine. A total of 38 states now require some coverage for the diagnosis and treatment of autism, including Utah where benefits will become available in 2016.
Light green denotes states with new coverage; dark green states have expanded coverage for 2015
"We enter 2015 with tremendous momentum to bring new or improved autism insurance coverage to more states so that more children can gain access to life-changing treatment," said Lorri Unumb, Autism Speaks' vice president for state government affairs. "The number of children diagnosed with autism continues to grow, adding urgency to our efforts in state legislatures, the courts and corporate human resources offices to make autism insurance coverage as widely available as possible."
Nebraska became the 36th state to enact autism insurance reform in April 2014. The Nebraska law requires coverage for state-regulated policies through age 20 for ABA and speech, occupational and physical therapies; ABA coverage is capped at 25 hours per week.
A month later, Maryland became the 37th state to enact reform by virtue of new state regulations and the enactment of a law expanding access to ABA practitioners. The Maryland law requires coverage for at least 25 hours per week of behavioral health treatment for children aged 18 months through age 5; decreasing to a minimum of 10 hours per week for ages 6 through 18.
Washington was declared the 38th state to enact reform in late 2014 after state regulators ordered all state-regulated health plans to start covering autism treatment in 2015 and to reconsider all claims for coverage that had been rejected since 2006. The order resulted from a series of class action lawsuits that led to settlements prohibiting any exclusions, age limits, monetary caps or visit limits for coverage of autism treatment.
Similar legal action led Oregon, which became the 34th state to enact reform in 2013, to accelerate and strengthen its required coverage. The Oregon law was to start phasing in this year, but was accelerated and the coverage broadened under an order issued late last year by the state insurance commissioner. Similar to Washington state, the Oregon order was prompted by a ruling in a class action lawsuit.
Coverage in Kansas is now available under many state-regulated health plans after a prolonged legislative campaign succeeded in 2014 to expand the state's original 2010 law which limited coverage to state employees. The new coverage provides up to 25 hours a week of ABA coverage for children up to age 12, declining after four years to 10 hours per week.
The Maine Legislature voted to expand its 2010 law requiring coverage through age 5 up to age 10. Gov. Paul LePage vetoed the bill, but the Legislature voted to override the veto to make the bill law.