Skip navigation

Calls to Action

Insurance Resources

Navigating the complexities of health insurance can be challenging, especially when trying to determine coverage for autism. The following tools and resources will aid you through the process.

Autism Speaks Insurance Link

Want to find out if you are entitled to autism benefits under your current health insurance plan? Visit our web-based interactive tool kit to find answers.
 

Early Periodic Screening Diagnostic and Treatment Toolkit

Under a program called Early Periodic Screening Diagnostic and Treatment (EPSDT), any Medicaid-eligible child under age 21 is entitled to all health care services that are found to be medically necessary to treat conditions discovered in the child. States are required to provide all such services that are coverable under the Federal Medicaid program regardless of whether the service is covered in a state's Medicaid plan. The EPSDT Toolkit was assembled to help families who are working to secure Medicaid payment for Applied Behavior Analysis (ABA) services. It is our hope that these materials make the process smoother for your family.

 

Self-Funded Employer Toolkit (ERISA)

Self-funded health plans are one of the most widely used forms of coverage offered by employers.  Because such plans are technically not “insurance” – meaning the risk is not transferred to a third party -- state insurance laws do not apply to them.  Self-funded plans are governed by federal law, and benefit packages are largely designed by the employer.  Autism Speaks has created this tool kit to help families advocate for meaningful coverage with their employer.

Federal Employee Health Benefit Plans

All Federal Employees Health Benefits (FEHB) plans now cover ABA but require prior approval for ABA services. Restrictions vary, and some plans specify who can provide services.  For more information on specific plans, please email us at familyservices@autismspeaks.org or advocacy@autismspeaks.org.  Our analysis is intended only as a guide; FEHB participants should carefully review plan offerings.  Full plan information is available here

 

FAQs: State Autism Insurance Reform Laws

47 states have required autism insurance coverage by law. Find out what your state requires and read more about Autism insurance reform.

 

Health Insurance Marketplaces and Autism

Autism Speaks has produced resources to help families better understand how the Affordable Care Act ("Obamacare") impacts their insurance coverage. The resources include fact sheets, basic information about the law and helpful links. Learn more here.

 

 

Questions? Call us at 888-288-4762 or en Español 888-772-9050, or email familyservices@autismspeaks.org or advocacy@autismspeaks.org.

 

To get involved in autism insurance reform, be sure to follow @AutismVotes on Facebook and Twitter and sign up to receive updates on our efforts here.