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Tuesday, November 22, 2011

Colorado Mandate Falls Short

Katie Kerwin McCrimmon writes at Solutions:

Jacoby Peel turned 3 on Sunday and no longer qualifies for therapy to help him learn to communicate and cope with autism.

His birthday was a celebration, but for his family, it also felt like falling off a cliff.

Until now, Jacoby qualified for intensive therapy through a Denver County early intervention program. Now that he’s 3, the family is on their own to pay for his therapy and eventually find care through the public school system.

“It’s scary,” said Jacoby’s mom, Jordan Peel.


Colorado passed an insurance reform law in 2009 and is one of 29 states that now require insurance companies to cover “evidence-based, medically necessary autism therapies.”

Despite that law, Peel’s insurance carrier, UnitedHealthcare, has deemed Jacoby’s therapy to be “experimental” and won’t pay for it. That leaves the Peels on their own.

“I’ve met parents in my position who feel the exact same way. You have a limited window of time in which therapy is most effective. Between the ages of 2 and 5, you can make the biggest impact. You want to do everything you can. I’ve known children who have done really, really well,” Peel said.

Peel testified last week at a public hearing called by the U.S. Department of Health and Human Services. Officials there are in the process of defining what health benefits are deemed “essential” under the Affordable Care Act. Peel was one of several autism advocates who pleaded with federal officials to invest in speech, occupational and behavioral therapy for young children with autism. The advocates are convinced that early intervention can dramatically improve the outlook for children with autism.

“Why should a child who is born with something have less coverage than someone who gets in an accident? There’s so much research that shows that intensive therapies can help children with autism,” Peel said.

“In the end, it will be so much less expensive for the system if kids can get in there and get coverage while they’re young…versus not being able to live independently some day. This is in everyone’s best interest,” Peel said.