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.
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 insurance plans are one of the most widely used forms of insurance coverage offered by employers. Because such plans are covered under federal law, they are exempt from state autism insurance laws. Autism Speaks has created this tool kit to help families find the coverage they need.
During the recently concluded open season, federal employees and retirees were able to select a 2017 Federal Employees Health Benefits (FEHB) Program health insurance plan that covers applied behavior analysis (ABA) for autism. All the FEHB plans cover ABA but require prior approval for ABA services. Age restrictions vary, and some plans cap the amount of services or specify who can provide them. For more information on specific plans, please email us at email@example.com or firstname.lastname@example.org. Our analysis is intended only as a guide; FEHB participants should carefully review plan offerings. Full plan information is available here
46 states have required autism insurance coverage by law. Find out what your state requires.
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. Log in here.
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.
To get involved in autism insurance reform, be sure to follow @AutismVotes on Facebook and Twitter and sign up to recieve updates on our efforts here.