Expanding Autism insurance coverage

Autism Awareness RibbonHouse Bill 498 — Autism Health Insurance Coverage — would require private health insurers in North Carolina cover the diagnosis and treatment of Autism Spectrum Disorders (ASD).

Legislation providing for autism health insurance coverage has been introduced in the General Assembly twice in recent years, but both times failed to gain enough support to even make it through committee; on May 15, HB498 overwhelmingly passed the House with a vote of 105 to 7. This bipartisan bill was introduced by Representatives Chuck McGrady, Tom Murry, Tricia Ann Cotham and Phil Shepard. There are 36 other co-sponsors of the bill.

ASD is a family of treatable neurobiological disorders that impact more children than cancer, AIDS, and diabetes combined. These disorders are characterized, in varying degrees, by difficulties in social interaction, verbal and nonverbal communication and repetitive behaviors which hampers their ability to become independent and productive members of society.

There are nearly 60,000 people with ASD in North Carolina who face significant barriers to treatment because of the financial hardship that this lack of coverage imposes. Autism disorders do not differ from other non-curable chronic medical conditions which are routinely covered by health insurance — including , diabetes, and hypertension — but health plans in North Carolina aren’t currently required to cover their diagnosis or treatment. 32 states have enacted some form of ASD insurance coverage and eight more are considering it.

“Families face the day-to-day challenges of raising a child with autism plus the additional financial hardships that result from health insurance exclusions. Unreimbursed out-of-pocket expenditures for medical care and autism treatment put families in financial insecurity, debt and even bankruptcy as they utilize savings and retirement funds to pay for needed therapies. Alternatively, families are forced to make the agonizing decision to not provide their child with these evidenced-based therapies known to improve symptoms dramatically.” —Tracey Sheriff, Autism Society of North Carolina

Key provisions of HB498 include requiring coverage for children diagnosed with Autism Spectrum Disorders by the age of 8 (most children are diagnosed around age 3 or 4) that would be provided through age 23 with a yearly benefit limit of $36,000. The legislation would provide opt-out exclusions to small businesses that employ 50 or fewer people if their insurance costs rose more than one percent in a year.

After passing the House, HB498 was sent to the Senate and referred to the Committee on Insurance.  Bill sponsors are hopeful it will be taken up when the General Assembly reconvene for the short session later this year.