While nearly every state requires insurance companies to cover autism therapies, most cut off mandatory coverage beyond childhood.
Age caps for people with autism are arbitrary since “they don’t suddenly become cured at age 18 or age 21,” said Lorri Unumb, CEO of the Council of Autism Service Providers.
This year, however, several state legislatures including New Mexico, New York, Utah and Virginia removed age restrictions on insurance coverage. About a dozen states now require coverage regardless of age.
Advocacy organizations like Autism Speaks, where Unumb worked until recently, have pushed legislators to make the changes. The trend moves the states into compliance with federal parity laws which require insurance companies to provide the same level of benefits for mental health care as medical or surgical care, Unumb said.
“It’s just relatively clear when you read the federal law, there can be no quantitative treatment limitations, and an age limit I would argue is a quantitative limitation,” she said.
Adults with autism might require different services, including employment, housing and rehabilitation in addition to any traditional behavioral therapies, advocates say.
Unumb, whose 18-year-old son Ryan has autism, said the insurance coverage laws can bring relief to worried parents. The family lives in South Carolina, where a bill has been introduced to remove the age restrictions, but has coverage for Ryan because their insurance policy is based in New York, which doesn’t have an age cap.
“(Ryan) is still essentially nonverbal, with some challenging behaviors,” she said. “He is somebody who will continue to need support, but he’s an able-bodied, strong 6-foot-tall guy who doesn’t want to sit around on the couch the rest of his life. He wants to contribute to society.”
Insurance coverage for adults with the developmental disorder will be a main focus of the Autism Law Summit in Wyoming this October, Unumb said. The summit is an annual conference on autism policy hosted by Autism Speaks and the Autism Legal Resource Center.
Advocates pointed to New Mexico as a model for autism coverage laws. While the state’s law passed this spring extended coverage to adults with autism, it also made the same requirement of Medicaid.
The New Mexico law dropped age limits on insurance coverage for speech therapy, occupational therapy and physical therapy for autism. Covered therapies under the law also include applied behavior analysis, considered a best practice for children but with limited research on its effectiveness in adults, according to a 2013 analysis in the Journal of Autism and Developmental Disorders.
Sam Crane, legal director and director of public policy at the Autistic Self Advocacy Network, said her organization generally supports removing age restrictions for insurance coverage but has concerns about the types of services that are covered.
“We would want to make sure that when these laws are changed, they still leave room for decisions about whether or not any particular therapy is appropriate,” Crane said.
While the group does not recommend applied behavior analysis for adults, diagnosis and evaluation services should be covered along with occupational and speech therapy, she said.
“We really need to take a second look at which interventions are actually being covered by the law, and that these bills cover a range of interventions,” Crane said.