Insurance Coverage for Autism Ruth Anan Ph D

Insurance Coverage for Autism Ruth Anan, Ph. D, 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!