How the Healthcare Law Affects Autism Coverage

Supreme Court and Healthcare Law

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Depending on whom you ask and which PR campaign you wish to believe, it’s called the Patient Protection and Affordable Care Act (PPACA), the Affordable Care Act (ACA), or simply, Obamacare. President Obama signed the healthcare law on March 23, 2010, and it was upheld by the Supreme Court on June 28, 2012. The healthcare law was intended to decrease costs and increase the number of insured Americans. Whether you prefer to call the law “Obamacare” or the “Affordable Care Act” is a strong indicator of whether you approve of the law or not. Few healthcare laws have been met with as much controversy as the ACA. Even the autism community appears quite divided. It’s not the purpose of this post to say whether the law is good or bad, but rather to discuss the potential impact of the healthcare law on autism coverage. You can read the full law here.

Expanded Coverage

Most healthcare plans will now have to expand coverage to young adults up to age 26. Your child can stay on your healthcare plan even if he is not living with you, not financially dependent on you, or married. This means that if your child is going to graduate high school soon, he can still rely on health insurance to cover any autism-related services that he requires.

Pre-Existing Conditions

If you have been unable to obtain health insurance for your child because his autism is considered to be a pre-existing condition, you can now do so. If he has been uninsured for at least six months, he can get health insurance through the Pre-Existing Condition Insurance Plan. If your state has not yet implemented this plan, contact the Department of Health and Human Services for a similar plan in your state. All discrimination against pre-existing conditions is slated to end in 2014. This means that not only can your autistic child receive healthcare coverage, insurance companies will not be allowed to charge higher premiums because of his autism.

Pre-Existing Condition Cartoon

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The exception to this is grandfathered plans. If you purchased your family’s health insurance plan on or before March 23, 2010, and it is not a job-related health plan, the insurance company may still deny a claim due to a pre-existing condition.

Applied Behavioral Analysis

The original incarnation of the ACA did not include provisions for behavioral therapy, which is shown to greatly improve the skills and abilities of those with autism. Because of the extensive lobbying efforts of Autism Speaks, an autism advocacy group, the final version of the bill does include provisions for behavioral health treatments, including applied behavioral analysis. However, not all insurance plans are required to cover these essential services. The coverage is only required for plans offered by state-based exchanges and plans offered outside the health exchange in the individual and small group markets. Autism Speaks has vowed to continue lobbying until all discrimination against autism coverage is prohibited, and all families with autistic children have access to needed services.


Health insurance companies will be prohibited from imposing any lifetime benefit caps. Annual benefit caps will also be phased out for self-funded plans. Beginning on January 1, 2014, most covered benefits will no longer be subjected to any annual dollar limits. However, services that are not considered to be “essential” may still have an annual cap.

Healthcare Costs

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Affordable Insurance Exchange

Some states have already implemented Affordable Insurance Exchanges. They are required nationwide in 2014. Individuals and businesses can use the exchange in their states to compare plans and enroll in public or private health insurance plans. You can also use your state’s exchange to look for additional programs to make health insurance more affordable. For example, get information on tax credits or affordable care plans like the Children’s Health Insurance Program (CHIP).


The Health Care Law & You

Insurance Choices

Families with Children and the Affordable Care Act

The Affordable Care Act & Children & Youth with Autism Spectrum Disorder

Parents' Guide to Reinforcing Speech Therapy at Home
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Legal Issues