Should ABA Services Have an Age Limit?
The ongoing debate about age limits for Applied Behavior Analysis (ABA) services coverage has sparked meaningful discussions within the healthcare community. These age limits often pose significant barriers to accessing crucial services like ABA therapy, even though there are efforts to ensure fairness in healthcare. In this context, parity means that insurance coverage for mental health and other disorders should be the same as for physical health conditions. Advocates across various states have been trying to eliminate age limits, stressing that physical and mental health needs are relevant at all stages of life.
Despite federal laws requiring insurance parity for ABA services, age limits are still often allowed, which affects the extent of coverage. A recent change in Blue Cross's policy, effective January 1, 2022, removed age limits from autism treatment services such as ABA therapy. This shift helps to reflect that age limits are not a valid way to determine medical necessity. Legal cases have also challenged these restrictions, with some courts finding that age limits violate the Americans with Disabilities Act. For instance, Blue Cross's updated policy, now allows members to continue receiving necessary services beyond age 19. Similarly, other court rulings have determined that Medicaid's age restrictions unlawfully prevent individuals with autism over 21 from accessing needed services.
Anthem's recent settlement over ABA therapy coverage also shows the impact of discrimination in insurance coverage. This settlement, which ended the use of coverage based on age, is a significant step toward improving access to essential therapies for individuals with autism. Personal stories, such as those of Chester and Kathryn Pierce, Michael Beck, and Joanne Kehoe, reveal the struggles families face when dealing with insurance limitations for ABA therapy. The Anthem settlement is particularly notable as it will financially compensate beneficiaries of Anthem health plans in Indiana. The approval of this settlement by U.S. District Court Judge Tanya Walton Pratt on March 28 is expected to benefit approximately 200 children. The Arc of Indiana, which advocates for people with developmental disabilities, hopes this settlement will reduce discrimination in health insurance plans—ensuring access to necessary therapies for individuals with autism. However, continued advocacy is still needed to protect individuals with developmental disabilities.
Kimberlee Rutan McCafferty's story provides additional insight into the challenges families face as their children with autism transition to adulthood. Kimberlee, who has two sons on the autism spectrum, is very concerned about the future of her eldest son, Justin. She discusses her concerns and offers advice through her experience by documenting them online. Her eldest son, Justin, is about to be 21 and will soon lose his school-based services. The uncertainty of this weighs heavily on Kimberlee. Still, she finds hope in seeing other families overcome similar challenges. As Justin faces the possibility of moving to a group home and leaving behind his familiar routines, Kimberlee and her family face tough decision-making, which is required to balance Justin's needs and desires. Despite the uncertainties, Kimberlee is committed to preparing Justin for independent living. Her story highlights the complex emotions and decisions that many parents of children with autism face, and her determination brings hope for Justin's future, with each new challenge offering a valuable lesson.
Personal stories, such as Kimberlee's and Justin's, emphasize the importance of ongoing advocacy to ensure fair access to essential therapies, regardless of age. To support these efforts, readers can take action by contacting state representatives, joining local advocacy groups, or visiting resources like the Autism Speaks website and the Autism Society of America. Autism Speaks supports proposed rules to reduce barriers to healthcare services, address administrative challenges, and prevent illegal denials of care. They focus on ensuring access to evidence-based practice, adherence to parity laws, and mitigating delays in care. Additional advocacy programs and resources, such as the Autism Society of America, The Arc, and local organizations like the Autism Alliance of Michigan, can offer valuable support for families navigating insurance coverage and accessing autism services. These organizations provide information and resources to help individuals with autism and their families.
Read this blog to learn more about what to expect from ABA services.
