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ABA coverage improves for federal employees in 2016, but gaps remain

December 10, 2015

Through December 14th, participants in the Federal Employees Health Benefits (FEHB) Program can make changes in their health insurance coverage for 2016.  The Federal health benefits open season offers families affected by autism an opportunity to review their coverage.  To aid this review, the Autism Speaks Advocacy team has looked at coverage of applied behavior analysis (ABA) under FEHB plans.

We found that ABA coverage is available under 2016 FEHB plans in part or all of 27 states. This is an improvement from the 21 states that covered ABA in 2015, but significant gaps in coverage remain:

  • As in 2015, none of the 15 nationwide health plans cover ABA.
  • Although close to 15% of the federal workforce lives around the national capital, only one area health plan offers coverage; no coverage is available for FEHB participants who live and work in the District of Columbia or Maryland.
  • Major metropolitan areas such as Boston, Charlotte, and Nashville lack coverage.  
  • Arizona, Georgia, Idaho, Kentucky, North Dakota, South Dakota, Tennessee, and Washington gained coverage in 2016, but Massachusetts and West Virginia lost coverage.

The 27 states with one or more FEHB health plans that cover ABA are Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Missouri, Nevada, New Mexico, New York, North Dakota, Ohio, Pennsylvania, South Dakota, Tennessee, Texas, Virginia, Washington, and Wisconsin.  

The map below illustrates ABA coverage:

Our analysis is intended only as a guide; FEHB participants should carefully review plan offerings.  ABA coverage may not be available in all parts of a state and, where available, may be limited to certain plans.