Skip to main content

Autism and Insurance Coverage State Laws

An update from the National Conference of State Legislatures has been posted to their webpage on insurance mandates by various states. The last change to a state law was posted in May 2011, but several changes will be taking effect in approximately a dozen states in 2012 based on these laws and language in the federal Affordable Care Act:

Autism and Insurance Coverage State Laws: A total of 33 states and the District of Columbia have laws related to autism and insurance coverage. At least 26 states—Arizona, Arkansas, Colorado, Connecticut, Florida, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Massachusetts, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, Pennsylvania, South Carolina, Texas, Vermont, Virginia, West Virginia and Wisconsin—specifically require insurers to provide coverage for the treatment of autism. Other states may require limited coverage for autism under mental health coverage or other laws.
Some states have passed laws with numerous exemptions, especially for their own state-operated insurance programs meant for families in need. Ironically, the ACA itself seems to allowing states to limit coverage of autism treatments. The reason for this is that the federal government has suggested states only need to offer specific minimums. The states have decided to follow federal minimums. For example, Arkansas amended their insurance law to read:
The law specifies that on or after January 1, 2014, to the extent that these provisions require benefits that exceed the essential health benefits specified under the federal Patient Protection and Affordable Care Act, the benefits that exceed the essential health benefits shall not be required of a health benefit plan when the plan is offered by a health care insurer in the state through the state medical exchange.
Of course, every insurance company will find a way to participate in the exchange markets if this allows the companies to decrease coverage offerings.

Most state employee plans offer coverage that is not mandated of other insurance plans, nor is offered to those enrolled in state supported programs. For example, Iowa's law reads:
Requires state employee health care plans to provide coverage for the diagnosis and treatment of autism spectrum disorders for individuals under 21 years of age.
The diagnosis has to be made by an "appropriate" health care provider. No specific guidelines are offered in the Iowa law, nor are they offered by most states. At least two states' laws mention the "DSM" without specifying the Diagnostic and Statistical Manual Fourth Edition, Revised. I don't know if this means coverage will expand or contract when the DSM V is published. Personally, I have no problem with laws being vague as to the diagnosis source or basis, since "autism" is an evolving diagnosis. I'd rather leave the health care issues to doctors instead of lawyers and legislators.

Read the NCSL updates and follow the links to your individual state's laws. Also, be aware that many insurance policies are set by insurance commissioners and other regulators based on the laws passed by state legislatures. This means that you should contact an insurance expert in your state if you have questions about coverage. There are too many changes between 2011 and 2014 for any person to keep up with them. Also, if court challenges to the ACA are successful, expect states and insurers to reduce various types of coverage, including autism-related insurance coverage.

Personally, I have no idea what to expect between now and 2014 in the courts or at the federal level. Follow the NCSL page, though, and you'll at least be aware of what the laws are at any moment: http://www.ncsl.org/?tabid=18246
Labels:

Comments

  1. Dixie RedmondOctober 1, 2011 at 7:03 AM

    Thank you for writing about such an important topic. I've placed your blog in my list of autism blogs. I appreciate reading from the perspective of someone who has autism.

    ReplyDelete

Post a Comment

Comments violating the policies of this blog will not be approved for posting. Language and content should be appropriate for all readers and maintain a polite tone. Thank you.

Popular posts from this blog

Autistic Burnout

Summer demands a lot of social energy, especially for parents. For autistics, the never-ending social calendar of summer can cause serious autistic burnout. Host C. S. Wyatt discusses his need to find a balance between social demands and self-care. Check out this episode!
Post a Comment
Read more

Autism, Asperger's, and IQ

"Aren't people with Asperger's more likely to be geniuses? Isn't genius related to autism?" A university student asked this in a course I am teaching. The class discussion was covering neurological differences, free will, and the nature versus nurture debate. The textbook for the course includes sidebars on the brain and behavior throughout chapters on ethics and morality. This student was asking a question reflecting media portrayals of autism spectrum disorders, social skills difficulties, and genius. I did not address this question from a personal perspective in class, but I have when speaking to groups of parents, educators, and caregivers. Some of the reasons these questions arise, as mentioned above, are media portrayals and news coverage of autism. Examples include: Television shows with gifted characters either identified with or assumed to have autistic traits: Alphas, Big Bang Theory, Bones, Rizzoli and Isles, Touch, and others. Some would include...
12 comments
Read more

Alex Plank and Jenny Palmiotto discuss "An Eventing with Ezra"

The film Ezra follows Max Bernal (Bobby Cannavale), a stand-up comedian living with his father (Robert De Niro), while struggling to co-parent his autistic son Ezra (introducing William Fitzgerald) with his ex-wife (Rose Byrne). Alex Plank, Associate Producer Alex Plank is a trailblazing autistic self-advocate and a pioneering leader in the autistic human rights. As an associate producer of the critically acclaimed movie 'Ezra,' Alex has made significant strides in both behind-the-scenes and on-camera roles. He is a champion of authentic and humanistic representation of autistic individuals in the film industry. With a deep commitment to challenging ableism, Alex advocates for a world where autistic people are valued and respected. This commitment extends to a broader condemnation of ableism in all its forms, with a specific focus on dismantling the barriers within the film industry that marginalize autistic talent and narratives. Jenny Palmiotto – Founder of Love & Aut...
Post a Comment
Read more