CHRT Report: New laws covering Autism treatment creating opportunities for care, challenges in access, supply

October 14, 2014 | Publication

A report examining current implementation of new autism laws in Michigan, released today by the Center for Healthcare Research & Transformation, reveals a changing environment for autism care.

Under these laws, state-regulated insurance plans must cover diagnosis and medically necessary treatment for children with autism spectrum disorder (ASD) from birth through 18 years and Medicaid and MIChild must now cover a specific evidence-based behavioral therapy, known as applied behavior analysis (ABA), for children with ASD from 18 months through age 5.

The brief, Autism Spectrum Disorder in Michigan, released in partnership with the Michigan Department of Community Health, examines how the new laws have enabled many children to be covered for treatment.

“Michigan’s autism policy changes aim to increase access to evidence-based treatments, and what we have seen following implementation is that this is true for many children in Michigan,” says Marianne Udow-Phillips, CHRT director. “For example, 1,300 children with private insurance or Medicaid have received applied behavior analysis therapy.”

In addition to expanding treatment coverage, the Michigan Legislature established a state fund to reimburse insurance carriers and self-funded plans that submit claims for the diagnosis and treatment of ASD. This is particularly important for self-insured plans, which are federally-regulated and are not required to follow these new coverage requirements. As of June 2014, 23 self-insured employers had begun offering the benefit, with many submitting ASD claims to the fund for reimbursement.

This transformation in coverage for autism treatment also brings some challenges in accessing care for families with autistic children. For example, before a child can obtain approved, covered applied behavior analysis therapy (ABA) therapy, Michigan requires that a medical diagnosis of ASD come from a designated provider. Currently, estimated wait times for privately-insured children to be evaluated range between one month and 24 months.

Another factor that can delay treatment is the limited number of credentialed ABA providers in the state. Depending on an individual’s insurance, ABA must be provided or supervised by a board-certified behavior analyst. As of September 2014, there were 248 certified behavior analysts in Michigan, of which fewer than half treated individuals with ASD. An expansion of university training programs may help meet the demand for services in the coming years. For example, MDCH allocated more than $2 million in funding to help several universities expand their training programs for behavior analysts and assistant behavior analysts.

“We see great promise in the autism coverage requirements, and in the way universities are increasing their programs so more providers can be trained and certified in approved, evidence-based therapies,” says Nick Lyon, director of the Michigan Department of Community Health (MDCH). “We expect to see more changes like this in the marketplace in response to the demands for treatment and the training requirements of providers.”

Tracking the outcomes of Michigan’s autism laws over time will provide valuable lessons for policy makers nationwide.

“While timely access remains a concern for those seeking treatment for autism in the state, there is much that other states can learn now about Michigan’s experience implementing new coverage requirements and encouraging payers to cover ASD services,” says Udow-Phillips.