Autism Insurance Coverage in Arizona
March 22, 2008 by Kristina Chew, PhD
Filed under Health
Yesterday Governor Janet Napolitano signed legislation that will eventually require insurance companies in Arizone to provide coverage for autism, the Yuma Sun reports. Only companies with at least 50 works and with employer-purchased insurance for companies will have to provide the coverage, and children up to the age of 8 can receive up to $50,000 in coverage per year, while children aged 9-16 would benefits capped at $25,000. Gretchen Jacobs, who has a 4-year-old autistic daughter, says that the “higher figure for younger children makes sense as there is evidence that early and intense intervention can make a difference.”
Being the parent of an older child, I’m inclined to think that parents with older children might feel somewhat shortchanged by the distinction. Therapies—speech, OT, physical—are just as crucial for older children, whose gains may not be as dramatic as those in younger children, but can be crucial as they move forward in life. I know the feeling of needing to do as much as possible for a young child in the hopes that she or he will be able to attend kindergarten and not need special education and other services throughout their whole lives.
My own son—-who will be in special ed for all of his education and who will need support through his whole life whether living in a group home or working with a job coach—-has gotten better and better as he has gotten older. But he still has many many needs and we never hesitate to take him to specialists and certain doctors and professionals who we know he is comfortable with (and who are “out of network”). Hoping that someday there can be equivalent insurance coverage for autistic children and autistic individuals in Arizona, and elsewhere everywhere.
It would be a better set up if the state provided the money under the rubric of education, rather than asking insurance providers to cover it.
I have been thinking the same. It seems that when people seek insurance coverage for autistic kids they have to say that autism is a health problem, disease, illness etc..
I may be in the minority here but I’m glad that this legislation pass in AZ. This will help many parents in providing services (ST, OT, PT, or ABA) for their dependents. I feel the responsibility to provide services should be shared by both education institutions and insurance industries.
Like you, Dr Chew, I also have seen how ABA therapies help my child to learn. However, the service is extremely expensive. As a single provider, it is challenging for me to pay all of the therapy expenses out of pocket. This bill if available in my state would help me tremendously.
I wrote about this earlier in the week as well. There’s a lot of high-fiving here in AZ among the autism community, but I’m not sure this law is going to be everything it’s cracked up to be. I highlighted some potential unintended consequences, as well as the lack of coverage for employees of companies with less than 50 people (a very large percentage in our state.)
I wasn’t too upset with the split in benefits starting at age 9 – I’m thinking that older kids spend a larger portion of their time in school, so parents don’t have to implement (and pay for) as many therapies. Younger kids might have 6 hours a day of ABA, in addition to their weekly ST, OT, PT, NMT, etc etc etc!!
Just my 2 cents..
Unfortunately, as this initial wave of state mandates pass, there will continue to be age limitations. It’s just the reality of politics … legislation gets whittled down into something that is passable.
Here’s to getting our foot in the door and continuing to work to cover all children and adults on the spectrum.
It will definitely be an example for other states on what to do and what not to do.
FWIW, the states with insurance legislation in progress that I *think* are still active at this time are CT, FL, HI, MI, MO, NJ
, OH, PA and VA. Those that were submitted but stalled or otherwise failed to pass: MS, WI and WV.
My understanding is that CA may be coming in with a bill in the near future.
Congrats to AZ, even with the limitations and caveats.
Yes, I think congrats are in order; I also think there is a tendency to emphasize services for younger children in the thought that they might “recover” or that “intensive early intervention” is needed most of all for best outcomes. Of course early intervention is crucial, but some need support throughout their entire lives.
I think this type of legislation needs to be very clear about what coverage is being mandated. Every worker covered by insurance will pay an additional premium out of each pay check. I can support and accept that as long as some of the snake oil salesmen are not cashing in on the coverage.
I have not seen any projections regarding the increased costs or what treatments are included as well as those excluded.
I read and track the bills for a policy grouplist, that is specifically interested in coverage of behavior analytic and related OT, PT and SLP-CCC. The coverage really varies from state to state on levels, services, providers and exemptions so you need to read specific bill texts to see what the proposals are, and the bill that is finally voted on can be substantially different after committee and floor amendment.
The most recent estimate is <1%/policy. I think that it illuminating to compare to other mandated services.
Report: Health Insurance Mandates in the States 2008
A State-by-State Breakdown of Health Insurance Mandates and Their Costs.
Council for Affordable Health Insurance (CAHI)
NB: Row 6 of table is est. cost of autism benefits
http://www.cahi.org/cahi_contents/resources/pdf/HealthInsuranceMandates2008.pdf
In New Jersey, it seems that it is ABA that would be covered. I have heard of parents (in NJ and elsewhere) seeking coverage for other biomedical treatments, or hoping to.
I don’t begrudge the younger kids. Even though older kids may need support (as I am well aware with Eleanor), the extant data supports the front-loading of services as impacting trajectory, and I see the extension of services through 16, and even 25 (as I believe Michigan’s bills request) as substantial improvement over the big zero that we encountered 9 years ago. I believe that many of these bills have specified review periods to see how implementation is occurring and effects on outcomes.
Regan.
Thanks for the link, it provided a useful overview. The impact per insured is less than I had expected.
VAB’s earlier point about seeking such services “under the rubric of education” resonates with me. I wanted to note how the AZ law provides more funds for younger kids as so much attention is now being paid to younger children, much more than there was to those who are older now.
That said, this thread is leading me to run through what we’ve spent on Charlie over the years and whether it was a lot more when he was younger.
Regan, Thanks for the link as well.
The article states “companies with at least 50 workers and with employer-purchased insurance for companies” will be mandated to provide autism coverage. I guess families working for big companies in AZ will be excluded since most big companies are self-insured and do not have to follow state regulation on insurance.
The thing is that therapies are covered by the state anyhow, if you can get them to return your phone calls. I don’t see the benefit of additional coverage if you already are covered by DDD.
The only thing that often isn’t covered is diagnosing autism (my son was dx’ed in CA under the Lanterman Act).
@KimJ,
So if you don’t mind my asking—-how hard is it to get them to return those calls?
Well, it took several months to start the intake process when we transferred my son’s case from CA to here. Once the intake was done, I didn’t hear from anyone for another 5-6 months for further evaluation. I didn’t understand the next step, a medical assessment to determine that my son couldn’t care for himself (what 7 year old could?). I asked what services would be available if we did the next round of assessments (my son already is eligible for DDD assistance because of his Dx) and no one would tell me. they said they needed to get him on the roster first. I also kept telling the people on the phone that my son didn’t require nursing care and they said it was okay that he could still qualify for “funding” if for example, he couldn’t find his home from somewhere else or he couldn’t make his meals. I got the picture that they were interested in him qualifying for money but not explaining for what. So, I stopped that part of the application process. So, he’s on the state roster for DDD but we get no services at all except through the school district (which is completely unrelated). We have a case worker that has never introduced his/herself.
One of the factors in being discouraged from signing up for services is that my son met all the eligibility in CA and yet they had no appropriate services for us besides respite care. They didn’t have useful therapies for a child considered “high functioning”. They kept saying they were used to “at risk” kids (children at risk for institutional settings or jail).
I rambled, sorry.
In response to KimJ’s comments about Arizona’s DDD staff & direction – we’ve found that the families who wait for the state to approve them, give them direction, and provide support for them, are going to be waiting a LONG TIME. The State, like many social services, is under-staffed, under-funded, and simply not very good at “driving the train.”
On the other hand, families who are very proactive generally don’t have these issues. In most cases, we’ll find our own services/providers, and then tell our DDD case worker what needs to be changed.
The beaurocracy doesn’t discriminate based on income, race, or any other status. But it definitely favors those who are proactive. Do your own research, determine what you want/need for your child, and odds are you’ll be able to get it.
I would like to know if anyone has a solution for those of us with a child on the spectrum and are self employeed.
Can we join a group insurance or what can we do to get the AZ insurance??
Thanks