The Politics of Autism includes an extensive discussion of insurance.
Governor Deal has signed Senate Bill 118, which amends Ava's Law by increasing the limits on the coverage of applied behavior analysis to individuals age twenty and under up to $35,000 per year.
Ava’s Law was originally passed in Georgia in 2015 after almost a decade of advocacy by the autism community. Ava's Law affects private health plans regulated by the State of Georgia and requires screening and diagnosis; speech, occupational and physical therapy; applied behavior analysis up to $30,000 a year for children ages six and under; and psychiatric and psychological care for autism spectrum disorder (ASD).
The law intended to reverse the discrimination that individuals diagnosed with autism experienced when health insurance plans specifically excluded any treatment specific to autism from their coverage. Families in Georgia struggled for years to access basic, evidence-based care, unable to pay out of pocket. Without the appropriate funding stream, the number of providers remained extremely low and long waiting lists developed across the state.
Although it was a huge step in the right direction, the initial passage of Ava’s Law was not without compromise. Although evidence indicates that therapy is effective across the lifespan of individuals with autism, the legislature amended the original bill to cap coverage of behavioral therapy at $30,000 annually and only apply the requirement to children ages six and under.
Advocates were grateful for the progress, but also determined to continue to work towards coverage for individuals with autism of all ages. Another critical step forward occurred in the 2018 legislative session when Senator Renee Unterman introduced Senate Bill 118. The bill simply increased the previous dollar cap on behavioral therapy to $35,000 annually and also increased the age cap on behavioral therapy from six up to the age of twenty.
House Insurance Committee Chairman Richard Smith, a longtime opponent of the bill, became its champion in the 2018 legislative session upon review of claims data reported from Georgia’s own State Employee Health Plan. On May 8, 2018, Governor Deal signed SB 118 which will go into effect on January 1, 2019.