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Sunday, January 19, 2014

Maine Legislation and the Affordable Care Act

The Maine insurance mandate only applies to children five and under.  In the state, Medicaid does cover ABA for severe cases but not for HFA.  A legislative proposal would fill the gap, as AP reports.
The measure, introduced by Democratic Sen. Colleen Lachowicz of Waterville, could also be a potential cost saver for the Medicaid program as some of those costs would be shifted onto private insurance, said Cathy Dionne, director of programs and administration of the Autism Society of Maine, who said she billed $860,000 to Medicaid for her son's treatment from ages 4 to 16.
In 2012, the state paid claims for more than 5,830 [sic: actually, 5,381] residents with autism spectrum disorders, which can cause social and behavioral challenges, according to a recent report by the Department of Health and Human Services. That's up 60 percent over five years, the report said.
But any bill that carries a cost will face an uphill battle this session as lawmakers grapple with a $119 million shortfall in the $6.3 billion, two-year budget and other financial issues.
The measure would result in higher monthly insurance premiums of nearly $1.50 per person, according to a report by the state's Bureau of Insurance. [Apparently the bureau took the report down.]
It would also cost the state about $742,000 a year, as the Affordable Care Act requires states to subsidize the cost of benefits mandated beyond those required under the law, the report said. Some autism treatment services will be covered under the new federal health care law, which requires insurers to treat mental health no differently than they do physical illnesses. But some companies still won't cover applied behavior analysis, according to the bureau. [emphasis added]

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