All 50 U.S. States Require Insurance Coverage for Autism After Rule Passed by Tennessee
All 50 states now require some level of insurance coverage for autism treatment, following a rule enacted in August by the Tennessee Department of Commerce and Insurance. According to a report this month by the Disability Scoop, all small and large group insurance plans in Tennessee are now required to cover treatment for autism that is “medically necessary and appropriate and is not experimental,” including applied behavior analysis, or ABA. Before the new rule was issued, insurance companies could define their own mental health benefits, but must now cover the treatment of autism and any other condition listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The movement to extend insurance coverage for autism throughout the country was led by parents, and began in the early 2000s. One staunch advocate is Laurie Unumb, CEO of the Council of Autism Service Providers, a Massachusetts-based non-profit advocating for autism care agencies. “When I started down this advocacy path a dozen years ago, the only families who could access ABA for their children with autism were wealthy families and those lucky enough to live in the few states (that funded therapy programs),” Unumb was quoted as saying by Disability Scoop. “Now, most families in the United States have coverage for ABA.”
David Mandell, director of the Penn Center for Mental Health at the University of Pennsylvania, believes mandates on insurance coverage are effective at increasing access to autism treatment, especially for young children. “The mandates result in slightly increased numbers of people getting treatment and more treatment for those already getting treatment,” Mandell said.
As noted by Disability Scoop’s report, gaps in insurance coverage remain, with many states only mandating coverage for children with autism, with cutoffs at age 18 or 21. “The country is a patchwork of autism laws,” Unumb (whose adult son has autism) said. “The mandates are really strong in some states and somewhat weak in others.”
“It’s what keeps me awake at night,” Unumb added. “After all of the progress we have made in all 50 states, still some child will get diagnosed tomorrow and will be unable to afford the treatment recommended by the doctor, notwithstanding being covered by insurance. That’s wrong.”