The state of Utah does not require private health insurance companies to cover the cost of treatment for autism. The results of this choice give insight into what could happen across the nation if other states allowed insurers to opt-out of coverage for this very important treatment.
It must be incredibly difficult to live in Utah, to have a child who has an autism spectrum disorder, and to have your health insurance company deny coverage for the treatment that your child requires. Parents whose child needs applied behavior analysis (ABA) therapy are going to be paying for it out of their own pocket even if their child is covered through the parent’s health plan.
Some families have resorted to moving out of state in order to find health insurance that will cover ABA treatment for their child. Others have attempted to get help through a pilot program that exists through Utah’s Medicaid program.
The pilot program will serve up to 250 children who require autism treatment for free. The last day to apply for a chance at this coverage was October 31, 2012. By the close of business on that date, parents submitted over 390 applications for the program. That number does not include the online applications that were still accepted through midnight that night, or the ones that had been mailed by that day and had not arrived yet.
The Utah Department of Health will hold a lottery to choose which children will be able to get the treatment they desperately need. Winners will be notified the week of November 12, 2012. These children will each receive 20 hours a week of ABA treatment in their homes and their caregivers will receive respite care. The total cost per child, per year, is $30,020. Coverage will stop in June of 2014.
The children who did not get selected in the lottery will get nothing. They won’t be able to receive free ABA treatment. Their parents will not receive free respite care. Children who were younger than two years of age, or older than six years of age, were not even eligible to apply for a chance to get the treatment they require.
There is concern over the amount of money that the tutors who are actually assigned to provide ABA treatment to the children who won the lottery will make. More than one provider is paying for tutors, and they aren’t paying the same rates.
Medicaid will reimburse the business for a certain amount, but the business gets to decide how much of that money goes to the tutors. Some are questioning if 20 hours of training is adequate to make an unlicensed person into an effective tutor.
The Affordable Care Act requires all health insurers to cover ABA treatment as of January 1, 2014. If the Affordable Care Act gets repealed, what is happening to families in Utah could end up happening to families across the nation.
Image by Lisa Brewster on Flickr