Michigan's autism bill, questions about coverage and funding

Mar 30, 2012

Yesterday, the Michigan Legislature passed a series of autism coverage bills that will go to Governor Snyder.

It was one of the first significant pieces of legislation to move through the legislature with broad bi-partisan support.

The bill requires insurance companies to pay for autism spectrum disorder (ASD) diagnosis and treatment for children up to age 18.

Under the bill, insurance companies regulated by the state will have to cover expenses for ASD therapy and diagnosis...

  • of up to $50,000 a year for kids younger than 7,
  • $40,000 a year for kids ages 7-13,
  • and $30,000 for kids up to age 18.

Questions about funding

The law will go into effect on October 1, but some questions have been raised about part of the funding for the mandated coverage.

On the same day the Legislature approved the autism coverage bill, a state Senate committee stripped out funding in the state's proposed Medicaid budget for treating kids six and under with autism.

In his budget, Gov. Snyder put aside $34 million for this kind of coverage. That's now been brought down to $100 by the subcommittee.

MPRN Capitol Bureau Chief Rick Pluta explains why:

"Republicans say they are not confident in the revenue projections they’re working with, and want to wait for the next fiscal forecast in May. After that, they’ll plug in new numbers to the budgets. The subcommittee also created $100 placeholders for a host of other programs, such as dental care for children."

So the $34 million estimate could change.

Just yesterday, the Centers for Disease Control and Prevention increased its estimate for autism prevalence rates. Instead of 1 in 110 children, they now estimate that 1 in 88 children will be identified with an autism spectrum disorder (ASD).

So this budget change shows that even though the state has passed mandated autism coverage, how much money is available for that coverage could change year to year as budgets are batted back and forth.

Who is covered by the mandate?

And there's a little more confusion over who is actually covered by this autism bill.

Kathy Johnson is the president of the Board of Directors at the Autism Society of Michigan. She says her office has been fielding calls from parents asking whether they can receive benefits.

"Everyone is still trying to figure it out," said Johnson. "Right now, parents don't know how to react. Should they be jumping up and down with excitement? Or will this new law not help them."

State insurance regulations, like this one, do not apply to "self-funded employer insurance plans."

Those plans are overseen by the federal government.

Most large employers, such as GM, Home Depot, or DTE Energy, provide benefits through a "self-funded health care plan."

Those employers can choose to cover autism as part of their benefits on their own, but they're not compelled to do so by this new legislation.

One of the main advocates of this bill, Lt. Gov. Brian Calley, who has a daughter diagnosed with autism, told the Detroit News he will not benefit from the bill because his state insurance plan is a "self-funded plan and benefits are set by the Michigan Civil Service Commission."

"This will benefit other families much more than mine," Calley said. "I'm in a fortunate position to have resources and connections, to be (among) the 1 or 2 percent of families in Michigan that have access to therapy. The vast majority (can't afford treatment), … and they don't get the therapy they need."

To find out whether your employer uses a "self-funded insurance plan" the state suggests calling your employer's benefits office.

Dave Meador, Executive Vice President and CFO of DTE Energy, was a big proponent of the autism legislation. He said when they were working out how to draft these bills, the goal was to cover as many kids as possible.

"There was the potential to create winners and losers under the plan," said Meador.

To account for that, the new legislation calls for an incentive program to encourage employers with self-funded insurance plans to adopt autism coverage.

The Autism Coverage Incentive Program will encourage these employers to add autism coverage to their plans by reimbursing them for the expenses they incur when providing coverage to kids with ASD.

Improvements in treatment in Michigan to follow?

Once its signed into law, Michigan will become the 30th state with mandated coverage for ASD.

Meador expects autism treatment will improve in the state as well.

"Right now, Michigan has 30 certified behavioral therapists to treat 15,000 kids with an ASD diagnosis, while Florida has 2,000 certified behavioral therapists," said Meador.

Florida is one of the states that mandates autism treatment coverage. A market exists for ASD behavioral therapists in these states, and Meador expects the same thing to happen here in Michigan.

So will this new autism insurance requirement affect you? Share your thoughts with us and help improve our coverage!