As of January 1st, Nebraska joined 36 other states that have adopted laws that require certain insurance companies to provide coverage for diagnosis and treatment of autism.
Legislative bill 254 was signed into law by former Governor Dave Heineman in April of last year. It requires some health insurance companies to cover up to 25 hours of behavioral therapy a week for autistic children until the age of 21. The law also provides coverage for speech and physical therapy, as well as pharmaceutical care.
Advocates of the mandate say the guaranteed coverage can be life-changing. “This wonderfull treatment exists that has been proven with evidence based on therapy data that is effective in helping children on the spectrum, but it’s out of reach for most families,” said Cathy Martinez, a Nebraska advocacy chair for Autism Speaks.
Martinez, who is the President of Autism Family Network in Lincoln, NE, helped drafted the bill in its early stages. She says limiting health care coverage for children with autism only hurts society in the long run.
According to a 2006 study by the Harvard School of Public Health it costs society $35 billion each year to care for individuals with autism. Research on applied behavioral analysis (ABA) suggests that 25-40 hours of therapy a week will lead to the best outcome, but reaching that goal without health insurance can get expensive.
“Applied behavioral analytic services can cost upwards to $30,000-$60,000 annually,” says Sean Peterson, the clinical director at Pier Center in Sioux City. Peterson heads the only center in Sioux City that provides applied behavioral analysis therapy.
Currently Iowa laws only require insurance companies to provide autism related coverage for state employees, but Peterson says he hopes to see that change. “In terms of state laws mandating autism coverage, they are huge. It’s expensive services; there’s a large burden on the family so anything that cost would be wonderful for those families.”
For non-state employees in Iowa, the Department of Human Services provides some assistance. The organization offers funding up to $36,000 per-individual through their Autism Support Program. However, with a budget of $3 million some families aren’t able to take of advantage of the assistance program.
ABA therapy can cost anywhere from 60 to 100 dollars an hour. With Iowa trailing behind the nation when it comes to autism health reform, Martinez says she hopes Nebraska’s new law will encourage change.