Maine State-Regulated Insurance Coverage

Maine requires meaningful coverage for autism under state regulated plans.

Maine’s autism insurance bill, LD 1198, was enacted in 2010 and became effective on January 12, 2011. It was amended into 2014 by LD 2768.

To which plan types does the STATE autism insurance law apply?

  • Individual Plans - YES
  • Fully Insured Large Group Plans - YES
  • Fully Insured Small Group Plans - YES

What services are covered by law?

  • Diagnosis
  • Habilitative or rehabilitative care (e.g. Applied Behavior Analysis)
  • Counseling services provided by a licensed psychiatrist, psychologist, clinical professional counselor or clinical social worker
  • Speech, occupational, and physical therapy

Does Maine have caps on ABA coverage?

Yes. The law limits coverage to individuals with autism 10 years of age or under and is subject to a maximum benefit of $36,000 per year.

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is a federal law that generally prevents group health plans and health insurance issuers that provide mental health or substance use disorder (MH/SUD) benefits from imposing less favorable benefit limitations on those benefits than on medical/surgical benefits.  This includes quantitative treatment limits like age and dollar caps.  Learn more here.

Where can I find more details about the Maine autism insurance law?

A copy of LD 1198 as enrolled can be found here.

A copy of LD 2768 as enrolled can be found here.

If you have additional questions, please email advocacy@autismspeaks.org.

 

Last Updated: December 2019

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