As Frederick Douglass famously said, “Without struggle there is no progress.” This has once again been proven correct as the federal government recently “clarified” that Medicaid is required to provide treatment for children with autism, including Applied Behavior Analysis.
Why is this such a big deal? First, some facts.
“Autism is a medical /neurological condition which impacts the way the brain functions. It requires early and intensive medical and educational interventions in order to have the best possible outcomes.” (Autism Health Insurance Project)
“One percent of the population of children in the U.S. ages 3-17 have an autism spectrum disorder. Prevalence is estimated at 1 in 68 births. 1 to 1.5 million Americans live with an autism spectrum disorder.”(Autism Society)
Applied Behavior Analysis (ABA) is a research validated intervention for people on the autism spectrum. Research shows that early, comprehensive and intensive intervention can lead to meaningful improvement in outcomes for children on the spectrum. Intensive can mean treatment at the level of 40 hours a week.
SO….
In our capitalist society, who is supposed to pay for 40 hours a week of ABA therapy? This is the crux of question. Organizations of parents and teachers of kids on the spectrum have been struggling to force insurance companies to provide coverage for this life-changing treatment. As a result of their efforts, some 37 states plus the District of Columbia have autism coverage mandates. As awesome as this is, it is not enough. According to the Autism Health Insurance Project:
“If a state has an autism mandate, it means that all fully-funded, state-regulated insurance plans must provide the benefits specified in the law. The specifics of the autism mandates vary from state to state, but each of the mandates require health insurers to provide the behavioral therapy Applied Behavior Analysis to young children with autism. Some states, for example Maine, only require insurers to provide ABA therapy until a child is 10-years-old. Other states set hours or visit limits on the benefit.” (AHIP)
Furthermore,
“Self-funded, or employer-sponsored plans, do not legally have to offer autism benefits even if a state has a mandate. It is up to the discretion of the company.” (AHIP)
In addition, “Just because a state has an autism mandate, does not mean it must require autism benefits through its Affordable Care Act plans. However, 24 states plus Washington, D.C., have opted in! They require insurance carriers to sell policies on their Affordable Care Act insurance exchanges that cover behavioral health treatments that include autism treatments such as Applied Behavior Analysis (ABA).” (AHIP)
Until now, Medicaid has been exempt from the mandate to provide coverage to low-income children with autism. But not any more! This is a direct result of struggle by parents and other autism advocates.
Under socialism, it will be the obligation of society to provide education and training to all in order to help each person achieve his or her potential. We don’t know what potential contributions from people with autism have been lost to society because children did not get timely treatment. This is one of the reasons why I fight for socialism. In the meantime, I salute the dedicated activists who have achieved this significant victory.
