Will Affordable Health Care Mean Coverage for Utahns with Autism?

One in 47 Utah children is diagnosed with an autism spectrum disorder. That’s why many Utahns are paying close attention to what last week’s Supreme Court decision means for autism insurance coverage in Utah.

Laurie Vandegrift knows first hand how difficult battles with autism can be.

“One of the things that I remember was trying to potty train my autistic son. I just remember him sitting on the toilet and I was trying to communicate with him and I looked in his eyes and I could see that there was no communication there.”

At the time Vandegrift didn’t know her son’s diagnosis, or that her younger son would be diagnosed with autism as well. She says because her children were diagnosed in the mid-1980s and didn’t need special medication, she did not have a problem with her insurance company. But she knows that isn’t the case for every parent. Especially with today’s increased rates of autism diagnosis.

“When my son was diagnosed with autism it was one in 10,000 children...so, very very different situation. All the parents are looking for answers and the insurance companies are overwhelmed, the schools are overwhelmed, the people are overwhelmed.” 

Saturday at Fairmont Park in Sugar House researchers along with families affected by autism got together for an annual picnic. There, Dr. Bill McMahon, professor and chairman in the Department of Psychiatry at the University of Utah, said he is hopeful that last Thursday’s Supreme Court decision will help many of the people he works with every day.

“Autism is an incredible challenge for parents because they recognize that something is wrong with their child, usually it takes while to get a diagnosis, most to not pay for the diagnostic evaluation and most do not pay for any sort of intervention services.”

Andrew Riggle, public policy advocate for the disability law center has been looking into what the passage of the federal health care reform could mean for people with autism.

“It is no longer considered a preexisting condition for children and will no longer be considered a preexisting condition for adults under the ACA in 2014. The other important piece is the elimination of annual and lifetime caps on the amount of coverage you can access in any given year or over the lifetime of a policy.”

Riggle notes the Affordable Care Act requires that certain essential benefits must be made available by insurance plans in the individual and small group markets: “It says that behavior health services, which many people are interpreting to include autism specific services like intensive behavior therapy and things like that, is one of the pieces.”

But he adds the law leaves a lot of work to the state, adding now it is time for parents to speak up and let their elected leaders know they want autism treatment to be included in an essential benefits package for Utah.