At today’s DC Council legislative meeting, Councilmember Charles Allen introduced the Health Insurance Coverage for Autism and Other Special Needs Amendment Act of 2015 to increase mandatory coverage of medically necessary autism treatments.

“Early diagnosis and treatment are critical to a positive outcome for children with an autism spectrum disorder. Early therapeutic treatment, including behavioral health treatment such as Applied Behavior Analysis, makes a significant impact on reducing symptoms and improving the quality of life and educational opportunities,” said Allen. “Many insurance plans do not provide for appropriate therapeutic treatment, leaving families to bear extreme out of pocket costs – as high as $60,000 per year -- or forgo this successful and necessary treatment.”   

The District requires coverage of this therapeutic treatment in the Health Benefit Exchange, through its Qualified Health Programs (QHP). The QHP market is the small group market, which reaches just 81,000 people. This leaves the nearly 150,000 children and adults who participate in the large group market without mandatory coverage of medically necessary autism treatment. The large group market in 41 states already covers these services. Those states have found that the impact on insurance premiums is negligible: the average cost per member is less than 50 cents per month.

The Health Insurance Coverage for Autism and Other Special Needs Amendment Act of 2015 would ensure that the large group market in the District also covers this treatment. This small investment can dramatically change the lives of children with autism, allowing them to learn or improve skills that lead to improved educational opportunities and a better quality of life.

Councilmembers Vincent Orange, Brianne Nadeau, Elissa Silverman, and Brandon Todd joined Councilmember Allen in co-introducing the Act.

Health Insurance Coverage for Autism and Other Special Needs Amendment Act of 2015

Bill Summary