Within the last ten years, there has been a tremendous push at both the state and federal level to ease the burden of families with children affected by autism spectrum disorder (ASD) in paying for treatment and other support mechanisms. According to a study by the Harvard School of Public Health, the estimated cost to care for an individual with autism over the course of his/her lifetime is $3.2 million. Another estimate shows that some families may spend upwards of $50,000 per year on therapeutic measures to treat autism. These insurmountable costs were coupled with little to no support from insurance companies or the government. This was due in large part to the misunderstanding about ASD and the lack of effective treatment measures. As a better understanding is being developed concerning how to characterize and care for those with autism, more attention has been paid to the families who are incurring the costs for these treatment measures.
With the Centers for Disease Control and Prevention estimating that one in every eighty-eight children has an autism spectrum disorder, it has become evident that this is an issue that needs to be brought under the scope of the government. Specific policies have been adopted by many states that relate insurance coverage for the treatment of autism. In total, 31 states and the District of Columbia require insurance companies to provide plans that cover autism treatment. Michigan is one of these states. As of April 2012, a package of bills was signed into law that required state regulated insurance companies to provide coverage for the diagnosis and treatment of autism. Lieutenant Governor Brian Calley, who has been a champion for changes in the way we deal with autism in the state, signed these pieces of legislation into law while noting that this would be the beginning of Michigan shifting from being “one of the worst 10 states to raise a child with autism to being one of the best.” Garnering bi-partisan support in both the House and the Senate, this package of bills was viewed as a necessary and effective way to assist individuals and families that deal with autism spectrum disorders.
The specifics of the bills mandate that only insurance companies that come under state regulations are required to provide coverage for autism related treatments. This does not include self-insured or federally regulated plans. Many big companies, like General Motors or DTE Energy have an insurance system that provides benefits through a self-funded plan. Though they were not required by the new laws to cover autism treatments, the legislation also appropriated $15 million to reimburse the companies with these plans if they choose to incorporate such changes in their coverage. This program, deemed the Autism Coverage Incentive Program, hopes to encourage many companies with self-funded insurance plans to adopt coverage for autism treatment, as lawmakers believe the incentive program will have to increase to $40 million in the span of five years for adequate reimbursements.
Other aspects of the legislation include annual caps on the amount that can be paid out to a family with a child seeking autism treatments. From birth to age 6, $50,000 is the limit; ages 7-12 in $40,000; and ages 13-18 is $30,000. These figures correlate with the estimate of the maximum amount some families have been found to spend on treatment measures for autism. This money can go towards a variety of things regarding autism diagnosis and treatment, including medical diagnostic testing through standardized tests and observation, applied behavioral analysis, speech and occupational therapies, and/or psychological and psychiatric care. The caps and the specification of what is to be covered is not rare to just Michigan. Several other states that have laws on the books requiring insurance companies to provide autism treatment coverage have very similar language. In Arizona, $50,000 is the cap up until age 9 and $25,000 to age 16. Arkansas allows $50,000 up until age 18, which is a bit more generous than our plan. However, several states including Florida, Illinois, Louisiana, and New Mexico set the cap at $36,000 for all ages up to 18. In all the 31 states that require insurance companies to provide coverage for autism treatments, Michigan serves to allow a bit more benefits, though overall most policies throughout the states are pretty consistent.
Along with this legislation in Michigan, Governor Snyder created the Michigan Autism Council in 2012 to be incorporated within the Michigan Department of Community Health. The purpose of this Council is to review and implement the Michigan Autism Spectrum Disorder State Plan, which has the broad goal of improving the quality of life for individuals and families dealing with autism. Specifically, they provide informational resources, implement evidence-based practices, and make the delivery of services more readily available. Along with this, they make recommendations to lawmakers on how to improve dealing with autism throughout Michigan. Suggestions they have made to increase the effectiveness of handling autism in the state include setting up a clearinghouse to direct individuals and families to services and resources related to ASD, increasing early screenings for children and set up a unified standard of identifying behaviors related to autism and proper referrals from there, and coordination among researchers at the university and professional levels regarding better diagnostic and treatment measures for autism. These measures, along with the already existing awareness by the state legislature of the importance of dealing with autism, will act to only improve the future implementation of effective mechanisms to deal with the disorder.