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Feds Approve ABA Therapy As Medical Benefit

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A recent change in federal policy could lead many more families affected by autism to gain insurance coverage for applied behavior analysis, advocates say.

In a major shift, the U.S. Office of Personnel Management said that it has determined there is enough evidence behind the use of ABA therapy to deem it a medical rather than an educational service.

The office is responsible for managing benefits for federal government employees, so the announcement paves the way for health plans offered to government workers to include coverage for the popular autism therapy for the first time.

What’s more, autism advocates say it sets an important precedent since the U.S. government is the nation’s largest employer.

“The OPM decision directly contradicts a long-standing insurance industry claim that ABA therapy is not ‘medical,’ but rather ‘educational’ — provided by the schools at taxpayer expense,” said Peter Bell, executive vice president for programs and services at Autism Speaks. “Now, tens of thousands of families will have better access to more affordable, critical ABA treatment.”

Currently, 30 states require that health insurance plans include ABA therapy, according to Autism Speaks, which has lobbied heavily for such legislation.

Under the new rules, coverage for ABA therapy may be included in health plans provided to federal workers starting in 2013.

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Comments (18 Responses)

  1. Carmen Allen says:

    great, so now we can call the ABA therapy that resulted in the need for restraint and seclusion rules a “medical” necessity. What a sad day for human rights :(

  2. Carmen Allen says:

    Does anyone know how this will affect school systems? can the federal government just ignore that ABA/PBS is codified in the Individuals with Disabilities Education Act (IDEA)? the federal government has given billions for ABA/PBS to schools, so what is the deal? i would be happy if they take ABA out of the hands of educators :)

  3. InTheTrenches says:

    As a parent of a child with Aspergers I can say from personal experience that ABA has been one of the single most important things in my son’s development. There is no restraint or seclusion in his treatment. In fact he interacts with typically developed children much better as a result. The uninformed comments by Carmen Hall are typical of people observing from the outside. Now if only self insured companies could be compelled to cover ABA treatment for their employees instead of taking advantage of loopholes created by their campaign contributions induced influence…

  4. MaMom says:

    In our state (Massachusetts) ABA is covered but only by some insurances and NOT universally by Medicaid or MassHealth. It would be nice to know if the Feds approving ABA for their employees will somehow push medicaid into covering it as well so that the benefit is received fairly by all and not just by those that can afford expensive health plans.

  5. Suzanne Aaron says:

    This is terrific news for our kids! School systems in our area have a very negative bias against ABA and they simply won’t provide it. And yet it is the way our son learned HOW to learn. Insurance providers don’t want to cover it, saying that it duplicates services that can be obtained through the public schools. If you have a bias against ABA and have never seen a GOOD program in action, then I invite you to do so. No restraint, no seclusion (that happens in schools, not ABA centers BTW). Our ABA center is filled with active, happy kids who are celebrated, and great progress is made every day. It is a miracle for the kids who require it.

  6. Janet Shouse says:

    Will this mean that schools will not be willing to provide ABA (if they currently do), because this therapy is now “medical” in nature rather than “educational”?

  7. Carmel Catuara says:

    Does anyone know which 30 sates already have insurance companies that do cover ABA therapy?

  8. Joshua says:

    @Carmen I have worked in the schools and am currently an ABA therapist at a private clinic. In the schools, children are put in restraints almost daily. I have seen one restraint in the private, clinical setting that uses ABA.

    The schools that “have” to restrain to keep other children safe, usually end up reinforcing the dangerous behavior — ABA teaches appropriate, socially valid replacement behaviors to counteract the negative behaviors.

  9. FlipYourBirds says:

    This is all well and good, but as it usually goes low income, uninsured, and/or disabled families are still left without any help, except in Florida! At least half of the children/teens/adults with Autism have been deemed disabled and as such receive Medicaid either b/c of income guidelines or through a waiver program. Nobody has stood up for these kiddos, whom need it just as much as families that can afford private health insurance that fits under the very NARROW restrictions of most of the state Autism insurance reform laws! Across the board, ABA should be provided to all no matter what method of payment if we as a society do not want to spend billions later down the road for nursing and/or group homes as a result of failing these children when something could have been done. ABA services cost more than most parent/s make in a year and few can afford the appropriate services, so these kids WILL grow up with minimal adaptive skills to function at a level necessary to be independent productive members of society! We will pay one way or the other! Imagine 1 out of 88 adults unable to contribute to society and needing to depend on us to provide EVERYTHING! FYI, we all know that 1 out of 88 is BS, b/c the stat was pulled from shady data (if interested, research how the CDC determines Autism rates)! We are already paying with our prison systems, due to failing our ADD/ADHD generation! Cheers!

    P.S. I would love to see parents start getting scripts from physicians that indicate “ABA must be the method of medical intervention provided to at all times”, which require the “medical interventions” be provided at school?! Could work! Just like orthotics for a child with a motor disability or a insulin dependent diabetic student requiring injections as treatment while at school. Schools must require the use while participating in educational activities :) Just a thought for anyone willing to push this in Due Process! It only takes one student to set precedence for the rest.

  10. Jeremy says:

    I am a psychologist and father of a child with autism. I also work for the federal govt and have been astounded that ABA is not covered by my ins. It’s very frustrating because the schools refuse to provide it claiming it is a medical treatment, while our ins company won’t cover it claiming it is an educational intervention! Talk about a catch 22. Restraint and seclusion has never been used with my son. In fact, ABA has worked miracles for us, and we have tried many therapies at great expense, almost to the point of bankrupting ourselves. This very welcomed relief and I hope it goes through as planned.

  11. Deborah Exum says:

    Coverage for ABA therapy is wondrful! It is time for all the help we can get….

  12. JoAnn Collins says:

    Here is the info to found out what States have enacted Autism Insurance Reform: States (30) with enacted autism insurance reform laws http://www.autismvotes.org/site/c.frKNI3PCImE/b.3909861/k.B9DF/State_Initiatives.htm. The site also talks about other States that are working on Autism insurance reform.

    I love this article–I do not care if ABA is considered medical or educational as long as all children with Autism have the right to receive it!! Here is some info about an ABA cost benefit analysis and how much is saved when a child receives ABA (in an appropriate manner of course–not the garbage that schools call ABA) “Cost-Benefit Estimates for Early Intensive Behavioral Intervention for Young Children with Autism-General Model and Single State Case.” Jacobson, John W., Mulick, James A., & Green, Gina. (1998). Behavioral Interventions, 13, 201-226. Demonstrates that providing behavioral treatment to all children with autism for three years, delivered between the ages of 2 to 6 years, would save approximately $200,000 per child for ages 3-22 years and up to $1,000,000 per child for ages 3-55 years. The savings per child even takes into account that some children will not benefit at all from behavioral treatment and some will only make modest gains.

    Childrent with Autism are not second class citizens and deserve treatment. Can you imagine telling children with diabetes that they could not get insulin–but schools and insurance companies turn parents away all the time when they request ABA for their child.

    Great article–and it is about time that the government recognizes ABA for the great treatment that it is.

  13. Paul A. Nidich says:

    Another important point is that ABA therapy ordered by a physician would qualify as a medical expense on Schedule A of the taxpayer’s income tax return. So, whatever insurance does not pay for, but you do, you can add it to all other medical expenses to reach the 7.5% floor for deductibility of these expenses. Also, remember to keep track of your mileage, as your drive you car to and from doctor appointments, pharmacies, therapy sessions, etc.

  14. John Best says:

    This is inane, exactly what I expect from the idiots who infest our government. ABA does not remove mercury from the brain so it’s a complete waste of time, effort and money. ABA can’t possibly help any autistic child. It may be useful for Asperger’s but the brain damage caused by the mercury in vaccines remains.

  15. jill taylor says:

    THANKYOU John Best! Why is the biochemical side of Autism…..apparently ignored by those that are prepared to spend $1000′s on other therapies??? Both ABA therapy AND mercury decontamination have been researched and shown significant results, especially when used together. The focus on ABA alone is so sad.

  16. Barbara in Tampa says:

    I have been trying to get help for my grandson for ten years now. i will take any thing i can get, and as for a cure the only thing that sounds promising is stem cell therapy.and im hopeing and praying that the goverment will realize that , and let up on the laws.

  17. Lacey Rose says:

    Iam so happy for the federal employees…but as I look at my son who is almost 7…Iam so frustrated that no one has gone after self funded insurances. As we hear about this person getting coverage and that persobabky getting coverage..it’s hard to stay celebratory while my son with Aspergers gets nodda.

  18. Audrey Smith says:

    John ….by the way..my son with Aspergers has never had any vaccines.

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