The current state of autism insurance is a maze of public and private programs regulated either at the state or federal levels with little consistency of purpose and ever-changing requirements. The extent of a family's coverage will depend on where they are employed, where they live and their income.
In this section, we offer resources on existing statutes, decided and pending case law, and regulatory decisions. Start here to determine which type of insurance involves your issue.
Self-Funded Health Plans (ERISA)
Approximately 25 percent of the U.S. population is covered under health plans self-funded by their employer. These health plans are regulated under the federal Employee Retirement Income Security Act (ERISA) which does not require coverage of autism-related benefits. Because these plans are federally regulated, they are exempt from state autism insurance reform laws. Go here.
State-Regulated Health Plans/Affordable Care Act Health Exchanges/Uninsured
An estimated 1 in every 5 American families is covered by a fully funded Large Group, Small Group or Individual health plan. Thirty three states have enacted laws requiring some coverage of autism benefits. Another 11 percent of Americans are uninsured, but will begin migrating into state-based health exchanges created under the Affordable Care Act starting in 2014. Go here for state information
Public Health Plans
Approximately 30 percent of Americans are covered under Medicaid (20%) or Medicare (10%), and another 10 percent are covered under state or local government employee health plans. The military (2%) is covered under TRICARE and federal civilian employees (2%) are covered under the Federal Employees Health Benefits (FEHB) program.
Go here for Medicaid
Go here for TRICARE
Go here for FEHB
Prepared by the Henry J. Kaiser Family Foundation and Consumers Union