States mandating autism insurance coverage
Given that most states seem to be moving towards covering autism, this argument does not carry as much weight as it formerly did.
The purpose of health insurance is to help spread the risk and cost of ailments across broader populations so that the burden of medical expenses does not fall entirely upon individual families. I am hopeful that was can get this legislation moving and join the rest of the country instead of being the last one to act.
Last week, I attended two separate forums on Virginia's exploding autism population, the lack of infrastructure to support it, and talking about ways to help families cope.
The law specifically excludes from this coverage requirement (1) mental retardation; (2) learning, motor skills, communication, and caffeine-related disorders; (3) relational problems; and (4) additional conditions not otherwise defined as mental disorders in the DSM-IV-TR (CGS 38a-488a and 38a-514). Insurance must cover medically necessary early intervention services for a child from birth until age three that are part of an individualized family service plan.
Coverage is limited to ,200 per child per year, up to ,600 for the three years (CGS 38a-490a and 38a-516a).s governor signed House Bill 2847 into law on March 21, 2008.
It prohibits certain group policies from excluding or denying coverage for (1) a treatment, including diagnosis, assessment, and services, or imposing dollar limits, deductibles, and coinsurance provisions based solely on the diagnosis of “autism spectrum disorder” and (2) medically necessary behavioral therapy services provided or supervised by a licensed or certified provider.
Here is a WAMU story about this past session's efforts.
One of the big arguments against this idea is that if other states do not mandate coverage, it puts Virginia insurers and eventually companies at a competitive disadvantage with other states because their rates and costs are higher due to this additional coverage.
Of these, eight require coverage for behavioral treatment services for the treatment of autism (Arizona, Florida, Indiana, Kentucky, Louisiana, Pennsylvania, South Carolina, and Texas) and five require other coverage related to autism (Colorado, Georgia, Maryland, New York, and Tennessee).