Michigan Autism Insurance Reform for Kids
The state finally passed a law in 2012 requiring insurance companies to cover treatment. As it takes effect Oct. 15, how will the medical community handle the influx of new patients?
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Like many parents of autistic children, Lisa Espinoza is excited by new state legislation that requires insurance companies to cover the high cost of therapy for kids on the spectrum.
Yet as the laws come closer to taking effect, she is not alone in harboring questions and concerns.
Espinoza's 12-year-old son, Logan, is non-verbal and has sensory issues common to kids with autism spectrum disorders. He will benefit from Michigan's Autism Insurance Reform legislation, which mandates that insurance companies cover speech therapy, occupational therapy for sensory-based interventions, and applied behavior analysis, the evidence-based treatment of choice.
Espinoza, who lobbied for five years to help pass the legislation as a member of the parent group Autism Insurance in Michigan, has high hopes the new laws will help not only her own son, but children across the state.
"I was always looking to find different therapies and came across the same roadblocks everyone else has – not being able to afford the treatment," Espinoza says. "If these children receive the degree and intensity of help they need, how many of them can regain normal functioning lives instead of being stuck in their own bodies, unable to express their needs and feelings?"
Yet on the verge of the legislation's launch in mid-October 2012, she is among those in the autism community who are left wondering if Michigan's therapy providers will be able to meet the anticipated demand.
By the numbers
According to the Centers for Disease Control, one in every 88 children (1 in every 54 boys) is affected with ASD, a complex neurological disability that has become a virtual epidemic in the United States.
In Michigan, more than 15,000 individuals are estimated to suffer from ASD. The new Autism Insurance Reform brings Michigan in line with at least 30 other states that specifically require insurance companies to provide coverage for autism treatment.
The package of bills (SB 414, 415 and 981) were passed in the Michigan Legislature on March 29, 2012, and signed into law the next month, in April. Insurance companies and autism treatment providers were given 180 days to put the new law into effect. What can parents expect on the magic date of Oct. 15?
According to Dr. Colleen Allen, one of the leading autism experts in Michigan, many questions remain unanswered.
Allen, president and CEO of the Autism Alliance of Michigan and chair of the Michigan Autism Council DCH (Department of Community Health), is working diligently with insurance companies, academia, treatment providers – and, most of all, families – to ensure the new laws take hold as seamlessly as possible. The organization has set up an AAoM Autism Insurance Collaboration website portal that is constantly updated to reflect latest developments, and AAOM has been touring the state hosting free seminars to educate people on the nuances of the laws.
Allen says one of her biggest concerns is there will be a glut of parents seeking treatment for their children – and a lack of skilled professionals to fill increased demand.
"Most of the challenges for our state going forward are those same challenges that have been experienced by other states that have already passed this. I fully expected a lot of what's happening right now, and it follows closely the issues around ramping up services," Allen says.
"You've got all these families now that are covered, the privately insured and Medicaid population, and you have so few therapists."
A new hope
Allen's greatest concern is in the area of applied behavior analysis, or ABA – an intense, one-on-one therapy that addresses behavior issues and skill deficiencies by breaking tasks into small steps, reinforcing behavior through repetition, and recording exhaustive data on individual progress.
"We've had speech and occupational therapy for children; those service providers have been in our state," Allen says. "What we have not had are board-certified behavior analysts (BCBAs). This is a new therapy type for our state that provides evidence-based treatment."
Experts, including Allen, agree that ABA is crucial to early intervention, but the treatment is not cheap. The therapy is recommended 20-40 hours a week, and at up to $60 an hour, many parents simply cannot afford it.