Disability News Service, Resources, Diversity, Americans with Disabilities Act; Local and National.

Friday, May 8, 2015

Best & Worst States to Live in 2015 If You Have a Child With Autism

as published by AUTISM HEALTH INSURANCE | April 2015

If you have a child on the autism spectrum, where you live has never mattered more. See how your state fares. 

Best & Worst States (By Insurance Coverage)
OregonNorth Dakota
(This article compares states by their autism insurance coverage laws. It does not take into account school district and other autism services.)
Where you live has never mattered more if you have a child with autism! Certain states have passed strong laws requiring insurers to cover autism treatments, while other states have not. A smaller number of states have gone a step further and required that intensive autism treatments be a required benefit in Affordable Care Act plans sold on the state exchange. And finally, while the federal government has told states that their Medicaid programs must offer ABA therapy for children under 21, so far only a handful of states have put this directive into action. Read on to see how your state fares.


Thirty nine states have now mandated some degree of insurance coverage of autism treatments., however five states in the nation have no such laws and no current plans to introduce laws which allow people with autism to access medically necessary treatments.  Presently, the worst states to live in if you have a child with autism are: Alabama, Idaho, North Dakota, Oklahoma, Tennessee and Wyoming.
Ohio, Hawaii, Mississippi and North Carolina each have either introduced autism health insurance legislation or are in the process of doing so (from Autism Speaks). Utah has passed legislation, but it does not become active until next year. With the exception of Ohio, these states have opted out of providing Applied Behavior Analysis (ABA) in their Affordable Care Act health plans sold on the state exchange. Thus, the only ways for a family to receive ABA for their child in most of these states are to work for an employer that voluntarily offers the benefit, or to obtain it through the school district, which frequently involves a protracted legal fight.


*Laws are constantly changing. Email us if something has changed and we missed it!  
ABA in ACA plans

ABA for Medicaid
DCX (with age limits)
GAX (with age limits)
HI (In progress)
MIXX (to age 6)
MS (In progress)
NC (in progress)
UTIn effect 2016
Very low-income families on Medicaid, despite their low socioeconomic status, may fare better in some states than their higher wage earning peers. In July 2014, the Centers for Medicaid and Medicare released guidance that ABA therapy must be offered to children under 21 across the nation, as part of the federal statute Early Periodic Screening Diagnosis and Treatment. This is a huge boon to low-income families impacted by autism as well as children who may qualify for Medicaid based on the degree of their disability. While CMS has stressed that care must not be denied or delayed, however, it has not yet given a specific time frame for when states will be assessed for compliance. 
To date, California, Connecticut, Florida, Hawaii, Louisiana, Massachusetts, Minnesota, New Mexico, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Vermont, Virginia and Washington are offering or in final stages of establishing EPSDT services for autism treatments through their Medicaid programs, though full compliance with EPSDT requirements remains an issue in many states. Washington D.C. offers some ABA through Medicaid with age limits, as does Michigan to age 6. Some of this coverage has been the result of litigation. Some states offer behavior intervention through Medicaid waivers, which waive traditional income requirements, rather than due to the recent Federal directive. Connecticut and Virginia’s implementations are questionable, as autism advocates argue that the state’s strict requirements—such as requiring a licensed caregiver to be present at all times during treatment-create too high a barrier to access. Tennessee’s Tenncare offers ABA, but require BCBA’s (board certified behavior analysts) only, not line therapist. South Carolina has begun offering the benefit but there are problems with implementation. West Virgnia is technically offering the benefit but obstacles exist to getting providers on board. 
Implementation for Medicaid through EPSDT in other states is a moving target. A number of states including Texas, New York, Utah, Montana and Georgia are in implementation discussions with their state Medicaid departments. Still other states are handling claims on a case by case basis or providing some coverage through Managed Care Organizations. Improved and more formalized coverage will likely occur in the coming year but will require sustained and consistent efforts. Autism Speaks has taken an active role in advocating for full and prompt compliance with EPSDT coverage requirements. “Kids on Medicaid are entitled to medically necessary treatments under the law regardless of what state they happen to live in” said Dan Unumb, Executive Director of the Autism Speaks Legal Resource Center.


Green states on the map offer ABA benefits in their plans sold through the ACA exchange. (Map courtesy of Autism Speaks)
Twenty-nine states have not only passed autism insurance mandates requiring private insurers to offer ABA therapy in state regulated plans, but they have also opted to mandate the benefit in Affordable Care Act plans sold on the exchange. These states are Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Illinois, Indiana, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, Ohio, Oregon, Texas, Vermont, West Virginia, Washington and Wisconsin (from Autism Speaks). Minnesota will require ABA in its Affordable Care Act plans, but not until 2016 .
Among the states, some laws mandate treatment without limitation, while others set age caps, limits on hours per week, and annual financial limits. Maine, for example, only requires insurers to provide the behavioral therapy Applied Behavior Analysis (ABA) until a child is 10-years-old, -- this represents improvement over their initial law, which mandated services until age 6. Nebraska has capped the hours of ABA at 25 per week. The status of these limits is somewhat in flux, however, as the ACA prohibits financial limitations on essential health benefits and other limits are increasingly being challenged and in many cases withdrawn in light of state and federal mental health parity requirements. Also, thanks to advocacy efforts of Autism Speaks, several state legislatures have recently or are in the process of expanding their mandates to treat children up to an older age, to provide more hours, or cover the individual market. (Kansas, Maine, South Carolina, Virginia). Many states only mandate ABA for employers with more than 50 employees. Autism Speaks is advocating that these mandates be re-examined and re-applied to include all with state regulated plans. The specifics of the mandates differ in each state.


Of the 29 states listed above, California, Massachusetts, Oregon, and Washington hold the distinction of the best states to live in if you have a child with autism. Each of these states:
1. Mandates ABA with no age cap, visit or financial limits.
2. Offer the ABA benefit on their ACA plans
3. Has or are in the final stages (MA) of implementing an ABA benefit for Medicaid through EPSDT.

(Disclaimer: Unfortunately, there are often bureaucratic and administrative obstacles to accessing benefits; however these states have the best laws in place with regards to insurance.)


The remaining states have passed autism health insurance mandates requiring private insurers to offer ABA therapy, however these states opted not to offer ABA in their Affordable Care Act plans. The states are Kansas, Minnesota, Iowa, Pennsylvania, Florida, South Carolina and Virginia. In some of these states (Florida, Pennsylvania, South Carolina), the mandate only applies to state-regulated plans with 50 or more employees. This is often a small piece of the pie.
April is Autism Awareness month and a good time to assess where the nation stands. The latest numbers from the Centers for Disease Control and Prevention report that 1 in 68 children have an autism spectrum disorder (ASD). This number is up from 1 in 88 children in 2012. Applied Behavior Analysis is still the strongest, evidence-based treatment proven to make a difference in children with autism. “Without these therapies, states will pay more and pay later, by missing the early intervention window to maximize potential,” said Dr. Karen Fessel, Executive Director of the Autism Health Insurance Project. “We applaud the states that have passed autism health insurance mandates and chosen to offer ABA in their health exchanges and through Medicaid.”
The Autism Health Insurance Project is a nonprofit organization that helps families and providers secure insurance coverage for interventions related to autism and mental health disorders. On a sliding scale fee, we act on behalf of families, filing appeals and grievances with health plans and state regulators in order to secure coverage of all needed treatments entitled by law.
*If you have specific questions leave them in the comments field at link,  they will be sure to respond visit:

No comments: