Insurance Coverage for Autism

Ruth Anan, PhD, BCBA-D

Center for Human Development

Division of Developmental-Behavioral Pediatrics

Meeting Name

Meeting Date

Meeting Location

Comprehensive Autism Assessment

I’m often the bearer of bad news

• After conducting an interdisciplinary assessment, our team of doctors may confirm that a child has an autism spectrum disorder

• Sometimes parents already suspect this and their fears are confirmed

• On other occasions, the diagnosis may come as a surprise and parents are unprepared for this bad news

Parents ask, ‘What would you do?’

• Intensive Applied Behavior Analysis (ABA)• Ample data demonstrating efficacy• Especially when treatment starts early• But there is limited availability of this

treatment in Michigan• Lack of insurance coverage for ABA is more

bad news for parents

HOPE Center

Beaumont’s HOPE Center

• Opened in 2002• GIFT (Group Intensive Family Training)

Program– Intensive ABA for preschool children– Short-term, parent-training model– Small group format

• Allows treatment to be more cost-effective• Gives parents sense of empowerment

GIFT Program

What does this treatment look like?

There has been some good news

• Our parent-training treatment outcome data were published in a peer-reviewed journal

• A few insurances now cover GIFT Program– Beaumont Employee Health Insurance– BCBS of Michigan has a special rider – Several out-of-state insurances companies that

already cover ABA treatment

But there is still a lot of bad news

• Although less expensive, parent-training still remains financially out of reach for many

• Parent-training places a significant on-going burden on parents as the primary providers of their child’s treatment

• For many reasons, intensive parent-training is simply not feasible for many families

• They need professionally-implemented ABA

Some more good news

• In 2004 we added another treatment model• CARE (Children with Autism Reaching

Excellence) Program• Delivers high-quality, intensive, professionally-• implemented ABA (for up to several years)• Preschool children receive individual therapy,

but in context of small group setting

CARE Program

Yes, it’s effective, but...

• It is cost-prohibitive for most families ($60,000/year for full time CARE Program)

• Almost no insurance in Michigan covers this individual, intensive ABA therapy

• Most parents “cut corners” by enrolling in CARE Program for only half-days when child’s condition warrants full-day treatment

It won’t be good news until it’s covered by insurance

Michigan’s children need good news!