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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.

Sep 26, 2012 06:45 pm
 Posted by  Carolyn

I am actually disappointed in this article for a couple of reasons. One it doesn't show both points of view on the legislation and also doesn't provide adequate information for those seeking support in what to do other than be directed to AAoM.

I was contacted by Ms. Buskirk about this piece, as a parent of a now twenty one year old son living with autism who has been actively involved now within disabilty policy for over two decades. I advised her of the view of many in this state and across the country. We are seeing bad policy being passed to build a cottage industry that at best will assist very few individuals on the autism spectrum. Data shows that.

Additionally what was not said in this article is the legislation does not provide for medical choice for families. Many research studies now show that many individuals living with autism have medical concerns that need to be addressed that behavioral intervention will not. It only comes to reason also if a child is in pain, and cannot communicate that, then they may have behavioral challenges.

We as a community have recognized this and many medical professionals in MI are now treating the root medical cause of many symptoms in children and adults with autism. It should be an option and also covered by insurance.

Only depicting those connected to the field of ABA and those that will benefit financially from this other than Ms. Espinoza, also does not assist those looking for other options that work like PLAY,RDI,& biomedical.

Lastly the bill S-981 is a discriminatory piece of legislation that uses tax dollars to pay private insurers to continue to discriminate. Limiting these bills by age and disability and using those funds for private enterprise also is a violation of ADA. It's unfortunate a new organization like AAoM, who has not been supporting those with ASD in the state, didn't realize that actively passing this legislation. Many groups that support families daily did not support these bills.

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