Saturday, November 22, 2008

At State Level, Progress in Insurance Coverage -- But More Is Needed

When you consider the real issues that affect families raising a child with special needs, the high expense for medical care and therapy is always near the top of the list. At least 26 states and the District of Columbia require insurance companies to cover people with autism, but that leaves a lot of states that don't.

Illinois is the latest state to make some progress in this area. Under legislation approved by the legislature this week and expected to be signed by Gov. Rod Blagojevich, insurance companies will be required to cover autism diagnosis and treatment up to $36,000 per year. It will cover these services for people up to age 21, and about 4,500 families will qualify for coverage. In the past two years, Texas, Pennsylvania, Arizona, Florida, South Carolina, and Louisiana have passed similar laws, some covering up to $50,000 a year per child. Autism Speaks has endorsed bills in New Jersey, Virginia, and Michigan and is targeting at least 10 more states in 2009, including New York, California, and Ohio.

For many children, ABA therapy (applied behavioral analysis, administered by trained therapists) is the most promising intervention, but it's very expensive, and many insurance companies refuse to cover the costs for it -- despite the fact that ABA has proven to be helpful for many children. According to Elizabeth Emken, vice president for government relations at Autism Speaks, "It's the No. 1 thing we hear from parents. What's more difficult than knowing there's an effective treatment for your children, but you can't afford to offer it to them because it's not covered by insurance?"

A proposed law in Oklahoma faces an uphill battle, but after being defeated in the last session, "Nick's Law" emerged as the very first piece of legislation proposed in the current session. (I have relatives in Oklahoma fighting hard to get this law passed, and if you're a resident, please contact your representatives.)

What kind of law applies in your state? Here's a state-by-state map from Need some talking points to advocate in your state? Autism Speaks has a 23-page document titled "Arguments in Support of Private Insurance Coverage for Autism-Related Services."

For a good overview of the issue, read "Parents Press Insurance Coverage" from CNN.
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