As many of you are aware, one of my twin 17-year old sons, Casey, is autistic. Casey was first diagnosed with his condition 13 years ago at the age of 4. Since that time, children suffering from autism have been diagnosed at record rates across the country.
The first reaction any parent has when their child is diagnosed with a serious life-altering condition is, what can be done to help my child? With autism, in addition to that question becoming difficult to answer, you quickly become aware and overwhelmed by the fact that regardless of the treatments that may be available to help, these treatments are not covered by health insurance. So, you quickly realize all of the treatment costs must be paid by you on your own. If you couldn't afford the treatments, your child didn't get help, until now.
Michigan Legislature Passed Autism Insurance Reform.
On March 29, 2012, the Autism Insurance Reform Bill was passed by the Michigan State Legislature. The governor recently signed this legislation, and insurance companies must comply with coverage requirements within 180 days of the bill's signing. This places the effective date in mid-October.
Passing the autism insurance legislation was the first step to creating a network of qualified providers who will be able to service children with autism in Michigan. Typical services and treatment include applied behavior analysis (ABA)-behavior therapy that is evidence-based treatment of choice for individuals with autism, and occupational therapy (OT) for sensory-based interventions and speech therapy.
The first important step as to whether your child may qualify for insurance coverage under the Autism Insurance Reform Act is to get an assessment to determine if your child has autism. To qualify for autism services, your child has to be assessed by a physician or psychologist who will use required diagnostic criteria. You may click on this link to find out more about the basic signs for autism: http://www.autismspeaks.org/what-autism.
Does This Legislation Impact All Insurance Policies?
Traditional insurance certificates and HMO's are covered by state law and therefore, must comply with this legislation. However, if you work for an employer that is self-insured, such policies are subject to federal law and therefore, are not required to comply with the state legislation. You should check with your employer to ask if they are "self-insured". If your employer is self-insured, all hope may not be lost in that the legislation included the creation of a state fund that helps pay for autism services when self-insured companies choose to self-adopt coverage. You should contact Autism Alliance for information and assistance by checking here if your employer is self-insured: http://autismallianceofmichigan.org/contact-us/.
What are Coverage Levels?
Services provided for under the legislation would be subject to the same co-pays and deductibles applied within your current policy. Basically, the legislation requires insurance coverage for individuals from 0-18 years of age for applied behavior analysis (ABA), speech and language therapy, and occupational therapy. The legislation allows insurance companies and HMO's to cap combined annual coverage of these therapies and other behavioral sciences (such as psychiatry) at the following levels:
$50,000.00 (6 years and younger)
$40,000.00 (7-12 years)
$30,000.00 (13-18 years)
Where Can You Find Help?
Families will need to check with their insurers about which therapists can be used for intervention. Insurers have the right under the new legislation to set up networks, or designate centers of excellence, and require that you use particular providers just as they do for other medical coverage. Due to decades of no coverage for autism in Michigan, the state lacks enough providers to immediately serve the needs of all children in the state who are suffering from autism. There are currently about 115 board certified analysts in Michigan, and only about 30 of those provide services to families with autism. There are over 15,000 kids in Michigan with the disability. Building the provider network is of greatest importance and while this may take some time, at least the infrastructures are beginning to be put in place.
Stay Tuned/Additional Resources.
Additional resources and updates will be available by contacting the following:
As well, check with your local centers or community hospitals' websites.
What About Casey?
We are blessed to have Casey as our son. Casey is a source of great encouragement and a model of courage and strength that we all, as a family, have learned from as he has grown up in our home. That being said, families with autistic children face very special challenges. The entire family dynamic is affected, not just the child who suffers from the condition.
Casey will be turning 18 in January of the coming year and is starting his senior year of high school this fall. While these circumstances often are greeted by typical high school seniors as exciting and with hopes and aspirations for the future, for Casey these times are very difficult. He struggles with the uncertainty as far as what type of college experience he may encounter. He likely will have to attend a community college and live at home with mom and dad for a period of time before attempting a more typical college experience at a larger institution. This uncertainty is even harder when Casey compares himself with his older brother and twin brother, who are very high academic achievers and either are or will be in situations with respect to attending larger universities and living on campus.
For a young man with autism who is turning into an adult at the age of 18, there are far more questions about his future than answers. Casey is very high functioning and bright, and feels the full impact of these questions and uncertainties. He is understandably anxious about them, as any of us would be in the same circumstance.
One thing we have learned with Casey is to never underestimate him, to have faith in God and to understand that he has a plan for our son. As Casey enters his senior year and as we as a family support him, please keep us in your thoughts and prayers.