How will new protections for pre-existing conditions affect health insurance for children with autism?
Many families are shocked when they learn that their private health insurance does not cover medically necessary care for autism. In Minnesota, children who have autism currently have limited options for affordable access to medically necessary care and treatment for autism. One of those options may soon disappear.
One option is Medical Assistance – which is available to all children who have a disability. This program is often referred to as “TEFRA” and requires that parents pay a percentage of the annual adjusted gross income (AGI) as a parental fee. (I like to call this a progressive tax on families who have disabled children.) Many families enroll their child with autism in MA-TEFRA in order to obtain coverage for Personal Care Attendants, or to access waivers, or to augment their private insurance coverage.
Another option is the Minnesota Comprehensive Health Association (MCHA). Until September 24th, children in Minnesota can enroll in MCHA by obtaining a “denial of coverage” when they apply for an individual health policy for their child who has autism. Many families have enrolled their child with autism in MCHA because it covers intensive early intervention behavior therapy — an effective and evidence-based treatment for autism. Most children will not have access to MCHA after September 23rd of 2010. The reason for this is that after September 23rd, health insurance plans will no longer be able to deny coverage to a child based on pre-existing conditions. Since children will not be able to obtain a denial of coverage, they will have a more difficult time accessing MCHA.
The good news is that since health insurance plans will no longer be permitted to deny coverage to children with autism who apply for an individual policy, savvy families should be able to pick and choose the right policy for their child. The trick is to find out which insurance plan best covers the treatment your child needs. Once you determine the best plan, you should be able to apply for that plan for your child (after September 23rd) and he or she should be able to get that plan at the current rates. Of course, how things should work and how they will actually work may depend on how health insurance companies “interpret” the new laws — and on how aggressive state and federal regulators will be in enforcing the new laws.
Amy Dawson is the parent of twins, one of whom has autism and special health care needs. She began practicing law in 1992 at the firm of Faegre & Benson, L.L.P. in Minneapolis. She also worked at the PACER Center and is a member of the Board of the Arc Greater Twin Cities. Amy’s law practice focuses on issues related to autism, disabilities, insurance and estate planning.
Bob Gunderson inspired me to devote my practice to individuals who have disabilities, their families, and the organizations that serve them. Bob Gunderson was my mentor, friend and colleague and I miss him very much. Bob Gunderson served the disability community as an attorney, as a brother, and as a dedicated volunteer who spent many hours in service to organizations such as Opportunity Partners, Fraser, PACER, and the Arc of Minnesota and Arc Greater Twin Cities.