Connecticut Joins 11 Other States In Autism Health Insurance Coverage

If you’re in Connecticut, and if you know somebody who has an autistic child, or have to take care of an autistic child, good news is coming your way. Spread the news fast.  Starting this month, families with private insurance plans are subject to an insurance fix that mandates coverage for medical needs of these children.

The law, which was pushed by state Sen. Martin Looney, D-New Haven, state Sen. Joseph Crisco, D-Woodbridge, and state House Speaker Christopher Donovan, D-Meriden, applies to private insurance plans and is effective as of Friday January 01, 2010 .

What’s Covered?

The law covers diagnosis, Applied Behavioral Analysis, speech, occupational and physical therapy and medications to age 14.

Families such as the McDonalds are breathing a sigh of relief as this law comes into effect at a time when money is getting harder and harder to come by.

Mrs. McDonald said her 4-year-old son, who cannot speak, has been getting Applied Behavioral Analysis since October 2009, thanks to an appeal by a Trinity College doctor who helped them win after their insurance company originally rejected the request.

The speech, occupational and physical therapy components the boy is receiving are minimal and the insurance coverage for Applied Behavioral Analysis, the only evidence-based treatment for autism, was only in effect until April.

“To have this bill pass is phenomenal. We would be pulling our hair out left and right otherwise…But thank God, come January, we’ll have no worries,” said Michelle McDonald, 39.

Shannon Knoll, a state chapter head of the advocacy group, Autism Speaks, said expenses can cost a family with an autistic child from $50,000 to $200,000 a year.

What’s Not Covered

NOTE: The law does not apply to companies that self-insure their health coverage, and it does not apply to children covered by HUSKY, the state’s Medicaid insurance for lower income families.

Knoll said Connecticut is only the 11th state to mandate this coverage from private insurers, and she said it sends a strong message.

Families like the Knolls are looking to federal health care reform to override gaps in the state regulations, but that is not effective until 2018, which will continue to leave her son, Jack, behind.

Asked why she continues to advocate, Knoll said the need is great, and she doesn’t want others to go through what her family has already faced.

With about one in 110 children on the autism spectrum, and 1 in 70 boys affected, the chances of it manifesting in the US population is high. That’s why there has been such a big push for autism coverage.

“Despite the fact that autism is a medical condition like any other, health insurers often inexplicably fail to include coverage for any autism-related treatments,” Sen. Looney said.

Knoll said her son had no functional language skills until he had ABA treatment. “Imagine not being able to speak. He did not say ‘mom’ until age four, but he is fairly high function right now,” said Knoll, who takes advantage of a school program with autism services.

This is awesome news. If you’re in Connecticut, make sure you get your insurance company to acknowledge this.

Other state which enforce autism coverage or has legislation for some form of autism coverage include: Oregon, California, Colorado, New Mexico, Louisiana, Kansas, Texas, Iowa, Maine, New Hampshire, New York, New Jersey, Pennsylvania, Maryland, Virginia, South Carolina, Georgia, Tennessee, Kentucky, Ohio, Michigan, Indiana, Illinois, and Wisconsin.

See the map below for details.

http://fmatlas.com/view/msgold123/20070527_StatesThatHaveAutismRelatedLawsAndAreConsideringThem

More Power To Us,

Erwin Chua

Consumer Advocate

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For more information, see: www. nimh.nih.gov/health/publications/autism or www.cdc.gov/ ncbdd/autism.