Autism insurance mandate will ease financial burden of therapies

Health Autism Insurance Coverage

The goal is to help to make the necessary treatments affordable for affected families.

North Carolina Senator Tom Apodaca (R-Hendersonville) originally sponsored an autism insurance bill in the state, in order to produce legislation that resulted from negotiating with insurers that had previously been opposed to the efforts of Apodaca and other legislators, in their attempts to require coverage for treatment of this spectrum of disorders.

Last year’s bill was supported by insurance companies, which were allowed to cap adaptive behavioral treatment.

Adaptive behavioral treatment is a term that encompasses a range of different programs, such as Applied Behavior Analysis (ABA). The cap that was permitted for this autism insurance coverage was at $40,000 per year, and payments were available only to patients who were aged 18 years and younger. This may appear to be a large amount of money, but these treatment programs are exceptionally expensive, costing many families around $4,000 per month; an amount that is clearly cost prohibitive for the majority of families. It also means that, for many families with a member who is on the autism spectrum, the cap falls short of treatment costs by two months per year.

That said, the autism insurance bill cannot provide universal coverage in the state for several reasons.

Health Autism Insurance CoverageApodaca’s bill is limited as North Carolina’s hands are tied when it comes to the regulation of Medicaid and other federal insurance programs. This has led advocacy groups to keep an ongoing effort to lobby not only at the state level but also on federal turf, in order to make it possible for autism treatment coverage to be further expanded.

Still, those autism advocacy groups have been keeping up a positive attitude. The Autism Society of North Carolina director of advocacy and public policy, Jennifer Mahan, explained that “I think all insurance legislation is generally incremental; you almost never get everything you want the first time around.” Mahan also added that “You’re going to have to make compromises or you won’t see legislation passed.”

It is also important to note that another struggle being faced in expanding autism insurance coverage is that the new law will not apply to people whose coverage is outside of a large-group health plan that is offered by a company with 50 participants or more.

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