ABA Therapy And Insurance Coverage.

What have states done to help ensure coverage of autism therapies?

Starting with Indiana in 2001, a total of 34 states and the District of Columbia have enacted autism insurance mandates, requiring carriers within their borders to provide coverage of ABA and other autism treatments in some or all of their policies.

States require insurers to cover nearly 2,300 categories of illness, treatments, and screenings.  Every state with an autism mandate requires insurers to cover ABA for state employees. Beyond that, state laws vary widely. 

What Does That Mean?

he ACA says state insurance mandates in place before Dec. 31, 2011 may apply to policies offered on the exchanges.  If a state requires commercial carriers to cover ABA, that same requirement may be applied to policies sold on its exchange.

However, when the administration directed states to define “essential benefits,” every state either chose a “benchmark plan” (defined as the small business plan in the state with the most beneficiaries) or let the federal government choose a similar plan for them. If a state’s benchmark plan includes a requirement to cover ABA and other autism treatments, then all the plans on its exchange must do the same.

What that means, there are many States that do not Have Autism Mandate and the States that do are relatively new and the coverage has not began being enforced.

At Compass we hope one Day each child dealing with Autism will receive appropriate care. We are committed to provide reassures and information for each caregiver so they can be informed and educated in treatment options they have for their child.