The cost of providing autism services can be significant.Last year, the Virginia Joint Legislative Audit and Review Commission estimated that more than 11,000 people with autism received assistance—including services in schools under the Individuals with Disabilities Education Act, Medicaid waivers and vocational rehabilitation programs—at a cost of more than $84 million.Some states have had difficulty keeping pace with the need for special education, especially in rural areas. States that do provide those special education services spend about $12,000 more per student per year, according to the U.S. Government Accountability Office.Ultimately, lawmakers must decide how much responsibility state government has to pay for the care for people with autism and how much lies with families, schools, health insurance providers and others. Legislators also must determine which programs and resources offer the best use of limited state funds. Court decisions could require states to provide certain services, such as Medicaid’s requirements to cover “medically necessary” treatment for children or federal special education requirements.Delaying services, however, can also cost. That’s why some lawmakers back early intervention that can lessen the needs—and costs—down the road, both for parents and the state.“We need resources in place now, not 10 years from now,” says [Louisiana Representative] Patrick Williams. “Our medical community, educational community and local-state-federal governments need to understand the effect this is having on our community. We have to work together to combat this disorder.”Early treatment will reduce the need for school-funded special education services and long-term support such as job training, Medicaid and adult day care.“With treatment, 47 percent [of children with autism] will recover typical function and another 40 percent will achieve significant improvement,” says Representative Kathy Angerer of Michigan.But “without early diagnosis and treatment, the average cost to the state over the life of a child with autism is more than $2 million,” she says.
A bill to mandate insurance coverage for Autism Spectrum Disorders (ASD) took another step forward Wednesday, as the joint Judiciary Committee sent the bill on to the full Legislature with a recommendation to pass it.
The bill will be introduced sometime during the 2011 session, which begins Jan. 12.
"We're excited that this got through today without any apparent opposition," said Delegate Barbara Evans Fleischauer, who cochairs the subcommittee that brought the bill forward. The full committee passed it on voice vote, with no nays registered.
Committee counsel Rita Pauley said the bill places ASD coverage into the state mental health statute. Other states have tried this, and it puts them on firmer footing looking ahead to federally mandated health care exchanges in 2014.
The bill requires the Public Employees Insurance Agency (PEIA) and all other group insurance providers operating in the state to cover ASD diagnosis and treatment.
It allows for necessary cost-containment measures along with annual lifetime and annual coverage caps, as long as they're not in conflict with the federal Affordable Care Act.