The states are creating a patchwork of available autism benefits as they begin implementing the Affordable Care Act (ACA) due to poor guidance from the federal government, according to an Autism Speaks analysis of preliminary data.
The states were requested to notify the U.S. Department of Health and Human Services (HHS) by September 30 what existing health plan they had selected to serve as the model, or benchmark, that many individual and small group plans will have to start offering in 2014. The ACA requires 10 categories of essential health benefits, including behavioral health treatment for autism, be included in the new coverage. The requirement affects individual and fully insured small group plans that were created after the ACA was signed into law in 2010.
In an examination of the 29 states that enacted autism insurance reform laws through 2011, Autism Speaks found that six had officially adopted a benchmark plan and submitted it to HHS and that benchmark plans had been recommended for approval in another eight states. The preliminary review of the plans found:
- The six adopted benchmark plans each require autism insurance coverage (Arizona, California, Colorado, Kentucky, New Hampshire and New York, shown in dark green)
- Four states with recommended plans include an autism benefit (Arkansas, Connecticut, Illinois and Vermont, shown in light green)
- The other four states with recommended plans do not include an autism benefit (Kansas, New Mexico, Rhode Island and Virginia, shown in red)
- The remaining 15 states (shown in yellow) either asked HHS for further guidance before they submit plans or their status could not be determined by Autism Speaks
- Alaska, Delaware and Michigan, which enacted autism insurance reform laws this year, were not included in the analysis because of a December 31, 2011 cutoff date established by HHS regarding state-required benefits