Health insurers must cover these autism treatments, Idaho says

A tattoo of an autism awareness puzzle piece.
A tattoo of an autism awareness puzzle piece. The Washington Post

Idaho is joining a long list of states that require health insurers to cover autism treatment.

The Idaho Department of Insurance on Monday issued a bulletin warning insurers that excluding autism treatments is against the law if their insurance plan covers other rehabilitative or habilitative services, such as occupational therapy.

The bulletin cites federal laws, such as a 2008 “mental health parity” law that says insurers cannot make it harder to get mental health care than it is to get medical care. For example, patients can’t be forced to pay higher copays or deductibles for mental health care than for anything else their plan covers.

Insurers will have to start offering the equal coverage for autism treatments — such as applied behavioral analysis — starting Jan. 1, 2019.

The bulletin stems from conversations the Idaho Department of Insurance began having last fall with insurers and consumers, said Wes Trexler, product review bureau chief at the Idaho Department of Insurance.

Insurers in other states have faced fines and lawsuits over denying coverage for autism treatments.

For example, Providence Health Plan in Oregon last year settled a class-action lawsuit over its denial of coverage for autism therapy. The insurer agreed to pay $10,000 to two families whose children were denied coverage and about $638,000 in attorney fees, the Oregonian reported.

Previously, Idaho was one of six states that did not explicitly require insurers cover autism treatments.

But even without the requirement in place, two of Idaho’s five major health insurers already covered it, said Dean Cameron, the director of the Idaho Department of Insurance.

The bulletin says insurers still can make decisions about whether autism treatment is medically necessary.

Autism is a range of disorders that hinder the ability to communicate and interact. Most doctors believe there is no cure. According to the Centers for Disease Control and Prevention, an estimated 1 in 68 American children are diagnosed with it.

Cameron announced the decision during a gubernatorial proclamation signing declaring April 2 “World Autism Awareness Day” in Idaho. The signing attracted families with children who have autism, health advocates who have long pushed for such coverage requirements in Idaho and Lt. Gov. Brad Little, who led the ceremony.

“Idaho is behind compared to the rest of the states ... but now you can go through the normal route to get these services with your insurance that you’re already paying for,” said Sharon Oberleitner, who has a 25-year-old son diagnosed with autism and is co-founder of a business that created an app for diagnosing autism. “This benefits the state, it benefits families, and it benefits the professionals looking to come here.”

Efforts to expand autism coverage have been in place since the early 2000s, where families in South Carolina and Indiana pushed lawmakers to pass laws that required coverage of autism therapy. Advocates say the trend has become more successful over the years as benefits of expanded coverage become more recognized.

The Autism Society of the Treasure Valley hosted a sensory-friendly Easter egg hunt at River Valley Elementary School in Meridian, Idaho on March 31, 2018. The annual event offers less chaos than your typical egg hunt - and, it is a way to bring f

Audrey Dutton: 208-377-6448, @audreydutton