Broad Success of California Autism Insurance Law Problematic

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Signed into law in October 2011 by Gov. Jerry Brown, the provisions of the California autism insurance bill (SB 946) went into effect on July 1. Now NBC Los Angeles warns that in spite of the law, there could still be "thousands with limited access" to pricey therapy.

What is the intent of the autism insurance law?

Certain health care plans must add coverage "for behavioral health treatment" targeting patients with autism or a "pervasive developmental disorder," Autism Votes explains. This treatment coverage includes behavioral analysis, which is a time- and cost-intensive early intervention.

Which types of California health plans are exempt from providing the mandated coverage?

Medi-Cal, Healthy Families and CalPERS participants do not qualify for coverage under the autism insurance law. Employees relying on work-provided health insurance may find that their plans are exempt from coverage, if the policies fail to include mental- or behavioral health services. Another exemption applies to employer plans that are self-funded and self- or third-party administered.

What health plans must provide the autism law coverage?

Third-party health insurers that sell a fully funded plan to a business must include the autism insurance provision. The same holds true for health insurers that sell coverage plans directly to a consumer.

Does the July 1 effectiveness date change California insurance law for good?

No, there is a July 1, 2014 sunset provision added by legislators who were counting on the Affordable Care Act to take over autism coverage.

How have consumers paid for behavioral therapy before the law took effect?

Patients, or their parents, looked to public assistance or depleted their personal resources to pay for the therapy. As noted by NBC, the intensive therapy "can cost thousands of dollars per month." In desperate cases, patients went without the treatment. CBS Los Angeles reported on children whose families were unable to afford the treatment and subsequently were not able to attend school.

What are the autism statistics for the State of California?

Relying on 2007 data, the Department of Developmental Services (DDS) noted that 19.09 percent of its clients presented with a form of autism. Some service centers had higher demands for autism-related services. Case in point is the Eastern Los Angeles Regional Center, where 30.94 percent of clients deal with autism. This number is up sharply when compared to 2002 figures. At that time, 12.13 percent of DDS clients presented with autism; the Eastern Los Angeles Regional Center served a client population of which 20.64 percent required services for autism. Easter Seals (Bay Area) publishes statistics that point to eight new autism case reports daily for the State of California. Diagnosis of children usually takes place between the ages of 6 and 9.

Sylvia Cochran is a Los Angeles area resident with a firm finger on the pulse of California politics. Talk radio junkie, community volunteer and politically independent, she scrutinizes the good and the bad from both sides of the political aisle.

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