Governor mandates coverage for autism; Insurers to include treatment, therapy

12/22/2012

COLUMBUS — Following the lead of 32 other states, Gov. John Kasich announced Friday that health-insurance plans in Ohio will be required to cover autism services for children by 2014.

The new insurance-policy directive drew praise from mental-health advocates and condemnation from business groups, but Mr. Kasich said giving more Ohio children with autism access to care is in the best interests of society.

“When we have the chance to do the right thing, we better do it, because we don't want to live life with any regrets,” Mr. Kasich said.

“Helping kids with autism get the services they need, and helping their parents get the financial lifeline of insurance coverage, that’s something I support — for state employees and other families as well. With early intervention, kids with autism do better at school, find employment, and become more independent, connected adults in our communities.”

The governor said Ohio will make autism services available to state employees and their 40,000 covered children after approval by the five state employee unions. Coverage details will be negotiated with the unions.

In addition, the governor said that autism services will be included in Ohio’s “essential health-benefit” package that federal law requires in every state beginning in 2014.

The package defines the minimum coverage that health insurers must provide in the plans they offer.

The state’s tax-funded Medicaid program for poor and disabled Ohioans already covers autism services.

Mr. Kasich’s action was applauded by advocates for autistic children and their families, but business interests say the mandate will increase health-care costs for small businesses already struggling to provide coverage to their employees.

The Ohio Chamber of Commerce said Friday that Mr. Kasich’s decision will increase health-care costs for small businesses.

“Their options for controlling these costs are limited, and today’s decision jeopardizes the health benefits many families count on,” said Keith Lake, a lobbyist for the chamber. “Why is Ohio going to require employers to provide an even higher level of coverage than the [federal health-care law] directs?”

Essential health-benefit plans are intended to mirror those provided under typical employer-sponsored health plans, but most don’t include this coverage, Mr. Lake said.

The U.S. Centers for Disease Control and Prevention estimates that 1 in 88 children have an autism-spectrum disorder, an increase from about 1 in 150 youngsters just five years ago. An estimated 60,000 Ohioans have the disorder. Advocates say the cost of treatment and therapy can reach $3.2 million over a lifetime.

The Kasich administration said the coverage required will be comprehensive but not unlimited. It will cover initial screening and development of a treatment plan; one-on-one treatment with a professional to develop communication, social skills, and like needs, and speech or occupational therapies. In all, insurers will have to cover 70 visits a year.

Several states, including Michigan, have approved changes mandating autism coverage within the past year.

“Thousands of Ohio children will have access to services to help them learn, and keep or improve skills and functional abilities that they may not be otherwise developing,” said John Stacy, executive director of the Autism Society of Ohio. He called Mr. Kasich’s action “a huge step toward improved support for families and individuals with autism.”