Children with autism and their families got long-awaited support from the 2013 Minnesota Legislature as the House and Senate passed legislation enacting autism insurance reform. Gov. Mark Dayton signed the measure as part of the omnibus health and human services bill. It takes effect in January 2014.
The reform measures are expected to provide financial relief for families who had been forced to sell belongings and refinance their properties to pay for the therapy. In some cases parents have had to change jobs in order to find insurance plans that provided the needed coverage.
The autism proposal was extensively debated and at least one parent group raised concerns about it. Debate over the changes pitted parents and families against insurers and business groups. Opponents are concerned that covering the therapy will be too costly.
Autism Speaks and the Autism Society of Minnesota, along with The Arc Minnesota were closely tracking the legislation. Sponsored by Rep. Kim Norton, DFL-Rochester, the insurance reform measure applies to state-regulated large group health plans which would be required to cover speech, occupational, physical and behavioral therapy, including applied behavior analysis, up to age 18.
An estimated 750,000 state residents would gain coverage. State employees will be added no later than 2016. The Dayton administration hopes to extend coverage to the small group and individual markets through the health exchanges it creates under the Affordable Care Act.
The bill also includes co-pay relief for families covered under the Tax Equity Fairness and Responsibility
Act or TEFRA disabilities program and a $12.7 million early intervention program for children up to age 18 who are enrolled in the state’s Medical Assistance program. The early intervention program will provide access to behavioral therapy, and will include training for providers in culturally appropriate techniques.
The provisions in Norton’s bill were incorporated into the omnibus health and human services finance bill. The legislation became more urgent after a landmark 2001 court settlement with Blue Cross/Blue Shield of Minnesota expired in late 2011. That took coverage away from many families, starting last year.
Lorri Unumb is Autism Speaks’ vice president of state government affairs. She was among those praising the legislation. “Autism Speaks commends the hard work of Norton and the Dayton administration in producing a comprehensive response to the lack of autism coverage in
Minnesota. We look forward to continuing our work with our Minnesota champions to extend coverage to all families.”
In April, Dayton expressed strong support for autism insurance reform. The governor met with families during World Autism Awareness Day event at the state capitol. He told families it is critical for public and private health insurance to align benefits so that children get the services they need, regardless of the type of insurance they have.
Initially, the mandate would affect only about a quarter of Minnesotans” those in state-regulated insurance plans. Most large employers, which are self-insured, are exempt from state mandates. But under federal health care reform, any new mandate would apply to plans sold on the new health insurance exchange, and state taxpayers would subsidize it. Officials estimate that would cost $3.5 million next year and $10 million by 2016. But advocates contend the costs could be less. They also note that the costs of therapy will have savings in the long run, as children need less intensive services in the future.
At the federal level, Dayton has contacted the U.S. Department of Health and Human Services and asked that the federal government require coverage for autism services, including applied behavior analysis, as the Affordable Care Act is implemented. Thirty-two states already mandate some form of autism coverage.
This contains information is from Autism Speaks, The Arc Minnesota and Session Weekly