Autistic Kids Need Insurance, Too


What’s the difference a law can make? How about $70,000 in families’ pockets? Autism advocates have new hope that a bill mandating coverage for behavioral treatments for autism spectrum disorder is making its way through the state legislature, albeit slowly.

Most insurance companies in North Carolina deny coverage for adaptive behavioral treatments by claiming that those therapies are more akin to education than to healthcare. However, adaptive behavioral treatments generally use specific psychological techniques of positive reinforcement and repetition that our schools are not set up to deliver. These are services rendered by trained professionals in fields such as speech and language therapy, adaptive behavioral analysis, and occupational therapy.

The other argument against the bill has been that mandating coverage for specific services raises the cost of insurance for everyone. However, in the >>38 states that have already mandated coverage for behavioral treatments, the average consumer cost has been limited to a couple of dollars per year for every person with insurance. Compare that to the out-of-pocket costs of up to $70,000 per year for a family paying for these treatments with no insurance coverage, and the cost of a couple of dollars per year seems like a great way to pay for treatments that will reduce the burden on social services providing special education.

>>Senate Bill 676 marks the third time that a bill to mandate insurance coverage for autism treatments has been introduced in the NC legislature. >>The past two times, the bill has made it through the House, only to die in the Senate. Now, it has been passed in the Senate, but we are still a long way from it being signed into law. The companion bill must pass in the House, and Rep. Chuck McGrady (R-Hendersonville) has introduced some serious changes to the bill that could slow down its progress but could ultimately make the bill stronger if the changes stick.

The main change being introduced concerns the definition of what is considered a “mental illness.” S676 excludes autism spectrum disorder from being classified as a mental illness. The federal government includes mental health services under its definition of >>“essential health benefits”, and insurers are prohibited from putting a yearly dollar limit on coverage for essential health benefits.

By excluding autism in its definition of mental illness, S676 opens the door for insurers to place a limit on how much coverage they provide. The current bill sets the limit at $40,000 and allows insurers to limit coverage to individuals 18 years of age or younger. These limits are are arguably what convinced insurance companies to agree to the bill and support it in the Senate, so it is unclear if the changes introduced by Rep. McGrady in the House will survive.

Even with the long road ahead, S676 is a big win for families paying for behavioral treatments for autism. It is also a testament to the power of individual voters to enact change – senators credit families and children who showed up to advocate as often as possible in Raleigh with keeping this bill alive and moving it forward.

>>Tiffany Frye 2Tiffany Frye manages a >>small but growing childcare and coworking cooperative and works as a managing editor for science publications. She lives in Durham, NC, with her husband and daughter.

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