Bill to Require Tennessee Health Insurers to Cover Approved Autism Therapies Fails
Tennessee is one of only five states in the country that doesn’t require coverage for applied behavior analysis, or ABA, from private insurers, leaving many parents to pay for therapies out-of-pocket.
The exception is children covered by TennCare or Medicaid.
Lorri Unumb, vice president of state government affairs with Autism Speaks, explains the disconnect.
“As of right now, children in Tennessee are not able to access ABA at all, regardless of what kind of health insurance policy they have,” she explains. “So, it’s this perverse situation where privately insured children in Tennessee do not have access, but children on TennCare do, at least in theory.”
Neighboring Alabama also doesn’t require insurance companies to cover ABA. Opponents to covering it say they’re against any law that would serve as a mandate.
According to the Centers for Disease Control and Prevention, about 1 in 68 children has been diagnosed with an Autism Spectrum Disorder in Tennessee. On average, medical expenses for people with autism are 4 to 6 times higher than others.
The Affordable Care Act lists what are called “habilitative services,” such as applied behavior analysis, as one of the essential health benefits insurance policies should cover.
Unumb says the problem is that how guidelines are interpreted was left up to the states.
“Rather than fleshing out what was meant by each of those 10 ‘essential health benefit’ categories, the Secretary of HHS (Health and Human Services) kicked the decision to each of the individual states,” she points out.
Numerous studies show that when offered at a young age, autism therapies can significantly improve a child’s ability to function, in school and later in a career. One study published in the journal Pediatrics, indicated ABA can even raise the IQ of a child on the spectrum.