Autism and the Affordable Care Act

Autism Speaks finds that fewer than half the states have planned to include ABA coverage in their new health care exchanges.

"While the picture remains somewhat murky, the unequivocal support needed by families dealing with autism clearly is missing," said Stuart Spielman, Autism Speaks' senior policy advisor and counsel. "We have an autism epidemic. Merely having some form of health insurance available will not address this epidemic."

The analysis was conducted on the "essential health benefits" benchmark plans each state was to submit to the U.S. Department of Health and Human Services (HHS). Autism Speaks reviewed information on the website of the Center for Consumer Information and Insurance Oversight, the part of HHS that wrote the essential health benefit rules, and found that 17 states were including coverage for behavioral health treatments and that coverage was implied by another five states.

In addition, Ohio Governor John Kasich in late December announced that his state would include ABA and other autism therapies as part of its essential health benefits package.

"Failing to categorize behavioral health treatment for autism as a mandatory element of the EHB package is not only bad health policy, but bad statutory construction as well," Autism Speaks told HHS in formal comments. Congress clearly stated when it enacted the ACA in 2010 that coverage for behavioral health treatment had to be one of the 10 essential health benefits each state was required to include as part of their new health care exchanges for the small group and individual markets

The 17 states determined to include behavioral health treatment include:

• Arizona
• Arkansas
• California
• Indiana
• Kentucky
• Louisiana
• Maine
• Massachusetts
• Missouri
• Montana
• Nevada
• New Hampshire
• New York
• Texas
• Vermont
• West Virginia
• Wisconsin

The five states where the coverage may be included, but is unclear, are:

• Colorado
• Connecticut
• Illinois
• New Jersey
• New Mexico