Sen. Anthony Pollina. VTD/Josh Larkin
Parents and lobbyists held a press conference Wednesday promoting a bill that would expand private insurance coverage for people diagnosed with autism spectrum disorder to include those older than 6 years.
In 2010, Vermont passed Act 127, which mandates that private insurance companies and Medicaid cover diagnosis and treatment for autism spectrum disorders for children from the age of 18 months to 6 years or when the child enters first grade.
The private insurance aspect of the 2010 law went into effect in October. The Medicaid part has yet to be implemented.
Sen. Anthony Pollina, the lead sponsor of the new bill, said the idea is to require insurance companies to treat people with autism the same as those with other health problems.
Only covering children up to age 6 is not sufficient, he said. His bill requires insurers to pay for services for autism regardless of the patient’s age.
“If you don’t continue beyond 6, you can lose a lot of ground,” he said.
Judith Ursitti, the regional director of state government affairs for Autism Speaks, praised the state for the 2010 law but said Vermont should do more.
“People benefit from early intervention, but autism doesn’t disappear once you reach age 6,” she said.
According to claims data from states that mandate insurance coverage, Ursitti says, on average private insurance company policyholders would only have to pay about 25 cents more each month to cover expanded services.
One insurance company, MVP Health Care, has estimated that the current law mandating covering up to age 6 would increase its premiums across the board 0.5 percent to 1 percent — enough to cause those on the edge of being able to afford insurance to drop coverage. Unlike other states, Vermont puts no cap on the dollar amount that insurance companies will have to pay per individual.
Parents of children with autism, however, say lack of private insurance coverage creates a burden for them.
Claudia Pringles has a 12-year-old daughter with autism. She dropped private insurance coverage for her daughter to receive assistance through the Medicaid’s Early Periodic Screening, Diagnosis, and Treatment Program. Still, most of the services her daughter receives come through school.
“After 3, I have no access to treatment,” Pringles said.
Pringles’ daughter is one of 183 children in Vermont who receive Medicaid assistance through what is called a Katie Beckett waiver, which disregards a parent’s income for a child with a certain degree of disability.
Switching to Medicaid is common practice for parents with children with autism since private insurance will not cover specialized services after age 6. Until October, when Act 127 went into effect, they would not cover any specialized services for autism.
Vermont’s 2010 law is the only one among the 29 states that mandate autism coverage to require expanded Medicaid coverage to the same level of private insurance. Essentially, in Vermont, Medicaid will have to cover the same services as private insurance. In other states, this is not the case.
Expanding that coverage for children up to age 6, the state Agency of Human Services estimated in a report, would cost $10 million. Ursitti said her group is working with the state to revamp that analysis to only include medically necessary treatments, which, she says will cost much less.
Gov. Peter Shumlin has proposed postponing these payments to save the state money.
Pollina said his bill focuses on private insurance, but it would require Medicaid coverage for children up to age 6. After 6, the mandate is only for private insurance.
In the Senate Committee on Health and Welfare Wednesday, Sen. Kevin Mullin, R-Rutland, questioned whether it is hypocritical for the state to require private insurance to cover services that the government will not cover through Medicaid.
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Perhaps if your readers want to hear a voice in all this. A short piece I broadcast recently on a mom who once lost her child with autism in Vermont. This boy had not had intensive communication therapy. Maybe it would have made a difference.
http://www.livingtheautismmaze.com/radiator_012612h.html
~ Anne Barbano
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I think Senator Mullin is missing the point. Medicaid is currently paying for 97% of autism treatments. Private insurance companies are raking in huge profits and denying coverage for proven treatments that help people with autism spectrum disabilities function better in society and be self supporting.
I pay almost $4,500 year in health insurance premiums plus thousands more in copays and deductibles but my two children who have ASD do not get counseling services because I can’t afford to pay for it out of pocket. It’s just not fair to discriminate against people with a certain disability to protect insurance company profit.
Requiring private insurance companies to cover ASD will save the State money and the studies are showing it would likely increase premiums by about twenty five cents per month. If a good portion of my health costs belong to the cost shift that subsidizes uninsured people howw is it fair to deny my children services that cost other people twenty five cents?
I am glad that 183 children are able to access Medicaid through the Katie Becket waiver, but that waiver ends at age 19. Autism doesn’t end at age 6 or at 18. The long terms costs of denying treatment for ASD to children and young adults like my children will far exceed the worst estimates of any cost to the State or insurance companies.
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Purely from an economic viewpoint investing in health care treatments or therapy provides society a return in productive tax-paying citizens. Moreover, what unforeseen, perhaps invaluable ideas and innovations might be shared when we help individuals realize potentials and communicate? Ultimately, it is only fair and ethical to help others to improve their quality of life, at the very least.
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It only makes sense to expand coverage! Autism is a LIFELONG disability. None of us stops learning, growing, changing by age 6-why would people with Autism be any different?
My son is diagnosed with Autism and gets Medicaid through the Katie Beckett waiver. Until last year, I also chose to keep paying the premiums on our private insurance. I did this to ensure that he was protected, and that his needs would be met.
However, my private insurer routinely denied coverage for my sons needs. For instance, Joey is functionally non-verbal. In order to function in the community, he needed a reliable form of communication, and a Voice Output device was prescribed. The device was expensive-well over $8,000. Cigna denied the claim. You and I-and the rest of the Vermont taxpayers- paid for it through Medicaid.
Cigna started denying coverage for my son’s occupational therapy-which is something that had been covered for 5 years. I eventually dropped our private insurance and let Medicaid cover these treatments since Medicaid does cover this treatment. the way things are here in VT, having private insurance actually gets in the way of having my child’s needs met.
The fact is this; my son has complex medical needs. Cigna had been covering his medical appointments, his medical procedures, his consultations with out-of-state specialists-they just aren’t covering the medically necessary, research-based treatments.
The regular denials of coverage due to “AUTISM”, led to our dropping private insurance when he turned 9. Now, Vermont taxpayers will be funding all of my sons medical appointments, all of his medical procedures, all of his consultations, all of his treatments……..I don’t believe that we, as a State, should be letting insurance companies off the hook and forcing the taxpayers to pick up their slack.
I need to point out that the cost of my son not getting appropriate treatment is, of course, significantly higher. He is a child who, without proper interventions and a strong family unit, could easily end up in an extremely costly out-of-state placement. Vermont taxpayers would, of course, have to foot the bill.
I’m really not asking for much. I’m not asking you to make Vermonters pay more. I’m just asking that you make the insurance companies pay their fair share.