For professionals in ABA therapy, there was a long, uphill battle for individuals with Autism Spectrum Disorders (ASD) to receive the attention and insurance coverage their conditions deserved. Through the years, the work of ABA and BACB therapists, alongside the efforts of organizations like Autism Speaks, has been instrumental in pushing forward legislation, litigation, and mandates across the nation that has improved the level of health insurance coverage for patients with ASD.
At Amvik Solutions, we know that as encouraging as these changes are, there is still a lot of information to sort through for the families of patients and ABA therapy service providers.
Remaining up-to-date on the current status of autism coverage throughout the nation is an essential element of what we do and is vital in helping you deliver quality care and treatment to your patients.
State Health Insurance Coverage By Category
Thankfully, the total number of states that provide legal basis for ABA therapy has never been higher.
However, one downside to all the progress is that there is still no federal mandate for uniformity all across the country.
All states can be divided into three separate categories:
States that have Specific Autism Mandates:
Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Texas, Utah, Vermont, Virginia, Washington, West Virginia, and Wisconsin (the District of Columbia also falls into this category)
States that have Limited Autism Mandates:
North Dakota and Tennessee
States with No Coverage:
Idaho and Wyoming
Altogether, there are 48 states that offer some level of coverage for ABA therapy. The Limited Autism Mandates in North Dakota and Tennessee require insurance providers to match the coverage for autism spectrum disorders with what they offer for other neurological disorders.
Issues With Coverage
The main problem with this increased level of coverage for ABA therapy across the country is that it comes without any sense of uniformity from state to state. This is compounded by the fact that many of the laws and policies supporting these reforms are constantly being revisited and reviewed, making their status require constant attention.
Part of the non-uniformity comes from the decisions that companies make on how they insure their workers. Those that provide their own insurance – typically large companies – do not have to conform to legal mandates and employees are left to find other avenues if the company does not cover ABA therapy treatment.
Additionally, smalls businesses are not penalized in some states for not offering health insurance coverage for autism spectrum disorder treatment. Outside factors like whether someone is employed by the state, insured under the Affordable Care Act, or covered by Medicaid also affects a family’s ability to find treatment.
The age at which a child can be covered also varies wildly. Depending on where a patient and their family live, they may be eligible for coverage from between the ages of 8 to 21. Many states also have coverage that decreases as a child gets older and falls between new age ranges.
Others set a maximum number of ABA therapy treatment hours each week that a patient can receive.
The annual cap on the total dollar amount changes as you cross state borders as well. As an example, the state with the highest cap for a year of treatment is South Carolina, which has it set at $50,000 every year until age 16. In contrast, California, Indiana, Massachusetts, and Minnesota don’t have any limit on coverage requirements, whether they concern age or other factors.
Obstacles in the Way of Continued Improvement
There is no consensus among state congresses on to how to go about implementing these reforms. This year, Alabama was able to pass a bill mandating coverage for autism spectrum disorder treatment but only after amendments were made to it prior to being approved.
Costs continue to be the main source of division between the lawmakers and other parties, like insurance companies and business groups. The lawmakers claim that requiring coverage will ultimately save families and states money long-term.
Insurance companies worry over sharp spikes in premiums, even though those increases have not matched projections. It continues to be an emotionally charged issue whenever legislation is involved.
Support the Cause
Both providers and families of patients have many opportunities to help overcome these roadblocks by getting involved with organizations that are founded around improving the rights and services those with ASD deserve.
Autism Society allows interested individuals to sign up for Action Alerts, which provide avenues to help advocate for people with autism, and give individuals updates on legislation so that they can correspond with their state officials involved with lawmaking.
Autism Speaks also coordinates the Autism Votes! Initiative. Those who get involved with this program will be able to learn about state and federal efforts to promote the rights of those living with autism and their families. It is dedicated to informing volunteers and turning them into advocates who can reach out to their local legislative representatives.
Amvik Solutions is your #1 ABA therapy partner. Contact us today at (805) 277-3392 to find out more about how we can serve your practice.
Amvik Solutions knows that ABA professionals face a number of challenges when it comes to starting and running their own practices. Don’t let legal battles being fought over autism coverage in your state take away from the importance of your work.
Contact us today and let Amvik Solutions offer you the support you need to run a successful ABA therapy practice with our credentialing, medical billing, management software and more.