Focus, Government, and Health Care

Autism insurance helps children, but more therapists needed

Recent change in law covers up to $50K per year.

November 10, 2012
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Autism insurance helps children, but more therapists needed
Therapists use tools such as emotions charts when working with autism patients. While insurance coverage for autism is better, state officials say more therapists are needed to provide suitable services. ©iStock.com/Macsnap
LANSING — The state now requires health insurers to provide diagnosis and treatment coverage for people with autism spectrum disorder, and advocacy groups say children with autism have more opportunities to receive treatment.

But experts in Grand Rapids, Southfield and Sault Ste. Marie say families still face major challenges in finding suitable services.

The average cost of caring for an individual with autism over his or her lifespan is $3.7 million without insurance coverage. Michigan has about 15,000 children diagnosed with autism spectrum disorder, and the lifetime cost to care for them is $58 billion, according to the Department of Community Health.

According to Sara Wurfel, press secretary for Gov. Rick Snyder, Michigan was rated one of the 10 worst states for people with autism. Now the state has joined 31 other states that have improved autism coverage.

More than 70 commercial insurance companies and 12 commercial health maintenance organizations are mandated to provide insurance coverage under a law that took effect in October. They must cover treatment up to $50,000 a year for each individual through age 18.

The treatment includes applied behavior analysis provided by a board-certified behavior analyst. Conny Raaymakers, a behavior analyst in Grand Rapids, said the state has 132 certified analysts, but not all practice in autism treatment.

Each week, she has 10 to 15 appointments, providing assessment and determining treatment methods for children.

“Prior to the mandate, each family would spend $50,000 to $70,000 on treatment,” she said. “And they all spent it out of their own pocket.”

Raaymakers said she anticipates more children coming in and receiving services.

Allison Greening, an analyst at the Early Intervention Center in Southfield, also has seen an increasing number of calls and visits from families seeking treatment for their children after the law passed.

“More parents were calling and asking about treatment and insurance. Some of them may move forward to coming in, seeing our facilities and meeting with our tutors,” Greening said.

Lt. Gov. Brian Calley, who signed the autism insurance bill package into law, said it won’t make any changes for his daughter, who has the disorder.

“My daughter was lucky to get what she needed,” he said. “The law would benefit many families who couldn’t afford treatment, and we need to ensure an independent future for autistic children.”

However, Calley said Michigan faces a shortage of professional therapists.

“We only had 31 behavior analysts for 15,000 children before,” he said. “Now we have 45, but we still need several hundred.”

Calley said it would take three to five years for more behavior analysts to come to the state, either from outside the state or through the university system.

In Oakland County, more than 2,000 children are diagnosed with an autism spectrum disorder. Lisa Kowalski, former president of the Autism Society chapter in Oakland County, said families would benefit greatly from the additional financial support and access to services for their children.

In the past, private health insurance did not always cover a diagnosis of autism spectrum disorder, occupational therapy services and applied behavior analysts, she said. Another challenge is the inconsistent network of therapeutic support for autistic children, with some areas having little to no access to those services, Kowalski said.

Although getting more specialists is an obstacle for Michigan, Ben Duff, president of Corner Pieces, an autism advocacy group in Sault Ste. Marie, said the law is the first of many steps for more children to receive treatment and benefits.

His son, Brian, became non-verbal at about 18 months, and the family had a hard time getting an official diagnosis and finding specialists in their county. He agreed that access to treatment might be a bigger obstacle than the cost for some families.

“Parents will do whatever it takes to help their children,” Duff said. “Not to say cost isn’t a factor, but if the services are available they will take advantage of them.”

His area has one or two specialists, while several are in Marquette, Petoskey and Escanaba.

“Specialists will never come if we don’t have the law,” he said.

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