By Hyndi Khomutetsky, MS BCBA
Co-founder & Director, Applied Behavior Center

A total of 35 states and the District of Columbia have laws related to autism and insurance coverage. At least 23 states—Arizona, Colorado, Connecticut, Florida, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Massachusetts, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, Pennsylvania, South Carolina, Texas, Vermont and Wisconsin—specifically require insurers to provide coverage for the treatment of autism. Other states may require limited coverage for autism under mental health coverage or other laws. **National Conference of State Legislatures NCSL

On May 2, 2008 Senate Bill 2654 was passed in Florida. Senate Bill 2654, which provides more health insurance benefits for autism and developmental disability therapies and enhances consumer awareness of the autism health insurance benefits. Statistics show that one in every 150 children develops an autism spectrum disorder, jumping to one in every 94 for boys.

Along with the passing of this bill, there has been a lot of confusion as to what this bill really means. Many insurance companies don’t even know what ABA is and some insurance companies are ignoring the mandate altogether. This can be frustrating for families as well as providers, but as the bill matures, progress and reform will hopefully be seen. For those insurance companies that are in compliance with the bill.

The basic autism coverage mandate is as follows:

Autism Mandate

1. Requires health insurance plans and health maintenance contracts issued or renewed on or after April 1, 2009, to cover the following:

  • Well-baby and well-child screening for diagnosing the presence of autism; and
  • Treatment of autism through speech therapy, occupational therapy, physical therapy, and applied behavior analysis provided by certified behavior analysts, psychologists, clinical social workers, and others.

2. Covers the following autism spectrum disorders:

  • Autistic disorder
  • Asperger’s syndrome and
  • Pervasive developmental disorder not otherwise specified

3. Benefits children under 18 years of age or in high school who have been diagnosed as having a developmental disability at 8 years of age or younger.