By ALANNA DURKIN/Associated Press/January 19, 2014
AUGUSTA, Maine (AP) More children would receive private insurance coverage for autism treatment under a bill being considered by Maine lawmakers. But the price tag it carries gives it an uncertain future in the Democrat-controlled Legislature this session.
Current law, which mandates that insurance companies provide coverage for treatment of autism spectrum disorder only for children ages 5 and under, is preventing families from getting effective, proven treatment for their children or forcing them onto Medicaid, say advocates who are pushing for the bill that would raise that age to 21.
Were basically boxing people into a corner, said Nancy Cronin, executive director of the Maine Developmental Disabilities Council.
Medicaid now covers applied behavior analysis treatment a regimen that psychiatric and medical professionals say is the most effective and promising for autistic children if their autism is so severe that they would be institutionalized without treatment.
But families may not want to go onto Medicaid or their child may have a mild form of autism, preventing them from qualifying for the approach that teaches children skills by breaking them down into smaller skills, she said. Furthermore, many children arent diagnosed with autism until theyre older than 5, supporters say.
The measure, introduced by Democratic Sen. Colleen Lachowicz of Waterville, could also be a potential cost saver for the Medicaid program as some of those costs would be shifted onto private insurance, said Cathy Dionne, director of programs and administration of the Autism Society of Maine, who said she billed $860,000 to Medicaid for her sons treatment from ages 4 to 16.
In 2012, the state paid claims for more than 5,830 residents with autism spectrum disorders, which can cause social and behavioral challenges, according to a recent report by the Department of Health and Human Services. Thats up 60 percent over five years, the report said.
But any bill that carries a cost will face an uphill battle this session as lawmakers grapple with a $119 million shortfall in the $6.3 billion, two-year budget and other financial issues.
The measure would result in higher monthly insurance premiums of nearly $1.50 per person, according to a report by the states Bureau of Insurance.
See original here:
Maine examines expanding autism treatment coverage