The Law and Autism Services

The Centers for Disease Control and Prevention (CDC) estimate that an average of one in 88 children have an autism spectrum disorder (ASD). More children than ever before are being classified as having autism spectrum disorders. The CDC estimates that up to 730,000 people between the ages of 0 and 21 have an ASD.

There is no cure for autism, but it is a treatable condition. Most health professionals agree that early intervention treatment programs are important. Treatment options may include behavioral and educational interventions, complementary and alternative medicine, dietary changes or medications to manage or relieve the symptoms of autism. These treatments may be costly. Some families may spend more than $50,000 per year on autism-related therapies, such as applied behavior analysis. A study in 2006 by the Harvard School of Public Health estimated that it costs $3.2 million to take care of an individual with autism over his or her lifetime and that it costs society an estimated $35 billion each year to care for all individuals with autism.

Some states require insurers to provide coverage for the treatment of autism. However, opponents to this approach argue that care for individuals with autism is the responsibility of parents and/or the responsibility of school systems. Others have raised concerns that mandating coverage for autism will significantly increase insurance premiums. According to the Council for Affordable Health Insurance, an autism mandate increases the cost of health insurance by about 1 percent. However, if the incidence of autism continues to increase and as more services are covered, the cost of insurance may increase 1 to 3 percent. This debate has intensified in recent years and states are taking a variety of approaches to meet the needs of children and adults with autism.

A total of 37 states and the District of Columbia have laws related to autism and insurance coverage. At least 31 states—Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Florida, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Massachusetts, Michigan, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, Pennsylvania, Rhode Island, South Carolina, Texas, Vermont, Virginia, West Virginia and Wisconsin—specifically require insurers to provide coverage for the treatment of autism. Alabama requires insurers to offer autism coverage in certain situations. Vermont amended their law to cover treatment for early childhood developmental disorders, which includes autism spectrum disorders. Other states may require limited coverage for autism under mental health coverage or other laws.

In the past few years, the debate over autism and insurance coverage has heated up in state legislatures. Most of the legislation to provide coverage for autism has been enacted in the last four years.

•  During the 2007-2008 legislative session, nine states passed legislation related to autism and insurance coverage. Arizona, Florida, Illinois, Louisiana, Pennsylvania, South Carolina and Texas enacted legislation specifically requiring coverage for autism. In addition, Massachusetts enacted legislation in 2008 to specify that autism shall be covered under mental health parity laws on a nondiscriminatory basis. Connecticut enacted legislation in 2008 that requires insurers to provide coverage for physical, speech and occupational therapy services for the treatment of autism spectrum disorders to the extent that such services are a covered benefit for other diseases and conditions under such policy. A summary of this legislation is included in the two tables below.

•  In 2009, Colorado, Connecticut, Montana, Nevada, New Jersey, New Mexico and Wisconsin enacted legislation requiring insurance coverage for autism. Illinois enacted legislation requiring insurance coverage for habilitative services for children with a congenital or genetic disorder, including autism.

•  In 2010, Iowa, Kansas, Kentucky, Maine, Massachusetts, Missouri, New Hampshire and Vermont enacted legislation requiring insurance coverage for autism. In addition, in April 2010, Oklahoma enacted legislation to specify that health insurance policies must provide the same coverage and benefits to children who have been diagnosed with autism as children who have not been diagnosed with the disorder.

•  In 2011, Arkansas, California, New York, Rhode Island, Virginia, and West Virginia enacted legislation requiring insurance coverage for autism spectrum disorders.

•  In 2012, Alaska and Michigan enacted legislation requiring coverage for autism spectrum disorders. Alabama enacted legislation requiring insurance plans to offer coverage for autism spectrum disorders.

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