The Covered California health benefit exchange board today is expected to reverse a policy that required all family members to join the exchange together, and that move is being hailed by autism advocates. They say a vital type of autism treatment now will be affordable for more California families.
Many families in California cannot afford to pay for applied behavior analysis (ABA) therapy, except through health insurance, according to Karen Fessel, executive director of the Autism Health Insurance Project, a not-for-profit autism advocacy group.
“Basically ABA therapy’s unaffordable when it’s not covered,” Fessel said.
Since it’s included as one of the essential health benefits for all Covered California policies, that makes it especially appealing for families with autistic children.
But until now, Covered California officials were insisting that everyone in a subsidy-eligible family had to sign up for same policy.
Today, when the Covered California board meets in Sacramento, there’s a nondescript agenda item called “Eligibility and Enrollment Regulations,” and the change in policy is expected to be included in that presentation.
“They originally said everyone in a family has to sign up for the same policy,” Betsy Imholz, special projects director for Consumers Union, said. “And that will be what most people will want to do. That makes sense for most people. However, there may be issues where they don’t want to do that.”
Families with autistic children could have that kind of issue, Imholz said, and the exchange’s staff members have made a commitment to accommodate them.
“They’re going to try to find a work-around,” Imholz said. “It’s going to be more complicated for them. But it’s a good result, we think.”
That was clearly Fessel’s opinion, who said this could mean greater access to ABA therapy for families.
“A lot of companies have plans where they pay 90% of the employee’s insurance, but the spouse and children have to pay half,” Fessel said, adding that some companies’ coverage does not include ABA therapy at all. Regardless, she said, this policy change will help.
“This will allow individuals to purchase plans that are affordable for the family,” she said.
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