Services for folks on the autism spectrum to be covered after age 8

Ian’s giggle radiates through the Capitol. His mom, Jessica McLaurin, gives him a soft “shh” and he responds with a bear hug.

Ian is on the autism spectrum and the therapy he’s received in last three years has improved his communication skills dramatically.

But insurance companies in Mississippi are only required by a state law passed in 2015 to insure for autism services up to age 8, requiring parents to jump through more hoops to prove medical necessity after that.

Ian will turn 8 in July.

On Tuesday, state officials announced they had come to an agreement with three large insurers, BlueCross BlueShield, Magnolia Health and UnitedHealthcare, to remove that age cap.

“That means that when he becomes an adolescent or even 10, we won’t have to scramble to find private services,” McLaurin said.

McLaurin found a private therapist that would see her son for $300 an hour without insurance. “I want him to have the services, but that’s just not feasible,” she said.

Removing the age cap is one step toward improving access to applied behavior analysis, the leading treatment for folks with autism or developmental disabilities. The service helps folks like Ian learn how to interact in different social settings, the classroom versus the grocery store, for example.

It also provides training for parents. McLaurin has had success with a technique for telling Ian "no" without actually using the word "no."

"'No' kind of does something to him. Instead we say, 'You know what, we're going to do that next time.'" McLaurin said.

At one point, Medicaid was reimbursing Ian's services, but when coverage dropped, McLaurin had to pay out of pocket. Instead of three days a week, she had to cut his therapy back to two.

Now, McLaurin doesn't have to worry about losing coverage through her current insurer, BlueCross BlueSheild, after Ian's birthday.

Secretary of State Delbert Hosemann, whose agencies oversees the Mississippi Autism Board established by the 2015 law, and Insurance Commissioner Mike Chaney worked together on the deal. The three large insurers cover roughly 90 percent of Mississippi children with autism and the other smaller insurers have no age cap.

Chaney said Hosemann helped him with one insurer who was hesitant to agree to the deal.

"He said, 'Let me see what I can do.' He went out there on his own nickle ... and visited with the CEO and moved the ball forward. That's the type of guy you have, people who make a difference. And when you work together in government you can move mountains and help your constituents."

The Insurance Department has also made available new online resources for parents, including an insurance reimbursement guide, a link to a list of applied behavioral analysis providers and providers in-network, a link to the autism spectrum disorder screening tool, an FAQ and insurance term glossary and other guides. These are available at mid.ms.gov/autism.

Navigating insurance isn't easy. Though the law guaranteeing coverage for children with autism passed in 2015, McLaurin spent all of 2016 working through the process, finally getting coverage in 2017.

"In my work, I visit with parents and children trying to navigate the complicated insurance system every day," Mississippi Autism Board Chairman Dr. Jim Moore said in a release. "We are grateful for Commissioner Chaney's leadership in aggregating resources to make finding critical information easier for those who need it."

Lori Unumb, a representative from Autism Speaks, a national organization that advocates for folks with autism, called the announcement unprecedented. She said she had just visited Idaho, one of only four states yet to address insurance coverage for autism services.

When telling Idaho representatives their state is behind, one asked, "Wait a minute, has Mississippi done this?" Unumb said.

"Now, I had to say to this person, 'In fact, Mississippi has not only passed this legislation, you cannot believe everything they're doing for their children with autism.'"

 

Source: The Clarion-Ledger