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.
