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State Exchanges Yielding Mixed Results on Autism Benefits

UPDATE: Massachusetts, Nevada Move on ABA Coverage; Deadline Extended to Dec. 14
November 14, 2012

NEW YORK (November 16, 2012) -- The states are creating a patchwork of available autism benefits as they begin implementing the Affordable Care Act (ACA) due to poor guidance from the federal government, according to an ongoing analysis by Autism Speaks.

The U.S. Department of Health and Human Services (HHS) has again extended the deadline, now December 14, for the states to identify what existing health plan will serve as the model, or benchmark, that many individual and small group plans will have to start offering in 2014. The ACA requires 10 categories of essential health benefits, including behavioral health treatment for autism, be included in the new coverage. The requirement affects individual and fully insured small group plans that were created after the ACA was signed into law in 2010.

In an ongoing examination of the 29 states that enacted autism insurance reform laws through 2011, Autism Speaks has found that seven have officially adopted a benchmark plan and submitted it to HHS and that benchmark plans had been recommended for approval in another nine states. The preliminary review of the plans found:

  • The seven adopted benchmark plans each require autism insurance coverage (Arizona, California, Colorado, Kentucky, Massachusetts, New Hampshire and New York, shown in dark green) Massachusetts acted since our last update
  • Five states with recommended plans include an autism benefit (Arkansas, Connecticut, Illinois, Nevada and Vermont, shown in light green) Nevada joined this list since our last update
  • The other four states with recommended plans do not include an autism benefit (Kansas, New Mexico, Rhode Island and Virginia, shown in red)
  • The remaining 13 states (shown in yellow) either asked HHS for further guidance before they submit plans or their status could not be determined by Autism Speaks
  • Alaska, Delaware and Michigan, which enacted autism insurance reform laws this year, were not included in the analysis because of a December 31, 2011 cutoff date established by HHS regarding state-required benefits

"The picture is still not clear for the future of autism insurance benefits despite clear direction from Congress (see video below) that they should be an integral part of the Affordable Care Act," said Peter Bell, Autism Speaks' executive vice president for program & services. "This is the result of poor guidance from the U.S. Department of Health and Human Services in helping the states implement the new law.

"We have all worked too hard over the last five years to end insurance industry discrimination against families raising children with autism and we will remain vigilant that those protections remain in place as the ACA is implemented by the states," he said.

Among the Congressional champions for protecting autism benefits in the new federal health care law has been Senator Robert Menendez of New Jersey. During a February hearing of the Senate Finance Committee, Menendez reminded HHS Secretary Kathleen Sebelius of Congress' intent when it enacted the law and questioned her department's commitment in implementing the law.