Monday, October 23, 2017

Reading the Research: State Autism Coverage

Welcome back to Reading the Research, where I trawl the Internet to find noteworthy research on autism and related subjects, then discuss it in brief with bits from my own life, research, and observations.

Today's article relates to insurance coverage and how much care autistic people, especially children, receive. As of this article, the researchers state that 46 of the 50 states have passed some kind of law requiring private insurers to cover at least some therapy for autism.  Their question was then whether that actually had an effect.

The answer, unsurprisingly, is yes.  Autistic families in states with coverage spent more money, and used it for outpatient treatments (various types of therapy) rather than hospitalizations.  Also, the longer the mandate for autism coverage had been in effect in a state, the more ASD-specific the care was likely to be, meaning these mandates spur the growth of businesses as well as boosting spending.

It's important to note here that not all states are equal in coverage.  Some states only mandate coverage for a small section of childhood, usually to age six or so.  This is due to the prevailing theory of Applied Behavioral Analysis (ABA), which suggests that this is the critical age range to target when trying to improve "functioning."  Others states recognize autism as a lifelong condition, and one requiring support throughout childhood, and cover much larger age ranges.

I found this an interesting read, and at least slightly promising.  My own state, Michigan, has a system I can only describe as "messy" when it comes to private insurances.  There was some sort of fund established by the state for re-imbursing private insurances for autism coverage, which the website says is depleted and won't be renewed.  From what I've heard from the parents I speak to, I would guess that autism coverage is either not mandated for private insurances, or not mandated save that very short age range.

Generally, when it comes to advising parents on how to get services, my thoughts go to one strong parent-advocate at the parent-support group I attend.  The man would probably never actually create a song and dance for it, but it's such a well-rehearsed subject that it might as well be: Medicaid is the golden ticket to all the supports and therapies for autism.  Once on Medicaid, you can apply through your local Community of Mental Health (CMH) for services appropriate to your child or yourself.

This is not really ideal for a lot of reasons, not the least of which is the standard assets cap.  Medicaid requires you to be dirt-poor, not just permanently disabled, to benefit from their services.  There are workarounds for that, which include the newly established ABLE accounts.  These let you save money to be used for specific expenses, and the money saved therein is ignored by Medicaid when assessing your assets.  There are also various "this disabled person would like to work and earn actual money beyond Medicaid's limits" programs, one of which is called Ticket to Work.

It's not an unworkable system, as evidenced by the various successful parent-advocates that use it.  But it is complicated in the extreme, and Medicaid is an unpredictable, ever-changing, bureaucratic, unholy nightmare for anyone not very experienced in its twists and turns.  I would much rather parents be able to simply use their work insurances to cover their children's needs... you know, like insurance is supposed to do... regardless of what those needs are.  So it's good to see a study like this, which seems to indicate that mandating such coverage has positive effects for everyone involved.  (The autistic kids get therapy, the parents get help understanding and working with their kids, the state economy grows due to new businesses, and the insurance companies get more business.)

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