With state health insurance exchanges now open for business, advocates say they expect plans available in only about half of states to cover autism therapy.
An analysis from Autism Speaks suggests that 26 states and Washington, D.C. will include coverage of applied behavior analysis, or ABA, therapy in insurance plans offered through their exchanges for individuals and small businesses.
Under the Affordable Care Act, insurers are required to provide 10 types of care — including behavioral health treatment — in all plans offered to individuals and small groups starting in 2014. However, determining what exactly falls within each of the required categories was largely left to the states.
As a result, whether or not insurance plans cover autism therapy will continue to depend on which state a family resides in, experts say.
“The devil is in the details,” said Katie Keith, a former research professor at Georgetown University who’s now consulting with Autism Speaks through her role as director of research at the Washington lobbying firm Trimpa Group. “Every plan will say it covers behavioral health treatment but I would encourage families to make sure they know what that means because every state will be different.”
What’s more, Keith warns that even in states where insurance plans cover ABA, there will likely be limitations. Under the Affordable Care Act, insurers cannot impose dollar limits, but will likely cap the number of hours or visits that will be covered, she said.
At present, the Autism Speaks analysis indicates that coverage of ABA will be included in health insurance plans offered through exchanges in Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Illinois, Indiana, Kentucky, Louisiana, Maine, Massachusetts, Michigan, Missouri, Montana, Nevada, New Hampshire, New Mexico, New York, Ohio, Rhode Island, Texas, Vermont, West Virginia, Wisconsin and Washington, D.C.
Most of the states identified by the advocacy group are ones that already required autism therapy to be covered by at least some insurance plans within their borders.
Health insurance exchanges across the country opened earlier this month, allowing individuals to purchase coverage that will be available starting Jan. 1, 2014.