Autism Insurance Legislation

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There are a number of efforts happening throughout the country to get autism treatments, or at least ABA therapy, covered in states. Parents and advocates are working together to get coverage. You can help too. Keep reading.

States that have insurance legislation in place (some better than others):

  • Arizona: Effective June 30, 2009. Covers therapy costing as much as $50,000 per year up to age 9, $25,000 per year up to age 16.
  • Colorado: Effective July 1, 2010. Covers ABA birth to age nine at $34,000 a year, then $12,000 a year until age 19.
  • Connecticut: Effective January 1, 2010. Covers ABA and assessments under the age of 15.
  • Florida: Effective April 2009. Covers $36,000 per year, $200,000 lifetime up to age 18.
  • Illinois: Effective December 2008. Covers up to $36,000 per year of treatment until age 21, plus Early Intervention.
  • Indiana: Already in effect
  • Louisiana: Effective January 1, 2009. Covers $36,000 per year up to age 17.
  • Minnesota: Already in effect
  • Montana: Effective Jan. 1, 2010. Covers diagnostics and treatments up to $50,000 per year from birth to 8, $36,000 a year from age 9-18.
  • Nevada: Effective January 1, 2011. Covers ABA up to $36,000 a year, until age 18, or if still in school, until 21.
  • New Jersey: Effective February 9, 2010. Covers screening and therapies up to $36,000 per year.
  • New Mexico: Effective June 19, 2009. Covers diagnostics and treatment until age 22, with numerous limits and caps.
  • Pennsylvania: Effective July 1, 2009. Covers $36,000 per year up to age 21, no lifetime cap.
  • South Carolina: Effective July 1, 2008. Covers $50,000 per year up to age 16.
  • Texas: Effective January 2010.  Covers treatment until age 10.
  • Wisconsin: Effective November 1, 2009. Covers $50,000 for 4 years, then $25,000 annually.

Please see www.autismvotes.org for more information on each state’s laws.

Want to get involved? Join the Autism Insurance Legislation Advocacy Group

Parity vs. Coverage

Parity means that if a particular therapy or treatment is covered for one diagnosis on their plan, then it’s also covered for autism.

Coverage means what treatments are covered.  The issue with ABA in particular, is that ABA is not a treatment for ANY other diagnosis and the insurance companies have been using that in denials.

Why Coverage in ALL States is Important

YOU NEED TO KNOW THIS!  You live in North Carolina but your insurance policy is funded and written out of Colorado.  Whose law governs your insurance?  Colorado.  The state where the insurance policy is funded and written is key.  The front page of your policy usually states where it’s written and funded.