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If Sarah Beppu’s family didn’t have health insurance, they might not be able to afford their son’s treatment for autism.
When 11-year-old Dylan was diagnosed with autism four years ago, he had to spend at least two hours in therapy every day. Fortunately, the services were covered by his mother’s health insurance plan.
Otherwise, Beppu’s family might have been looking at a $60,000 annual bill, according to the advocacy group Hawaii Families for Insurance Fairness. “If it wasn’t covered by insurance, I don’t think most families would be able to afford it,” Beppu said.
Because Dylan received treatment early, he doesn’t need intensive services at home and is doing well at school, his mother said.
Health insurance companies are not required to help cover the costs of autism treatment in Hawaii. Senate Bill 791, which was introduced by Sen. Josh Green, would require insurance companies to cover the diagnosis and treatment of autism for policy-holders and their children. The bill has survived the early rounds of the Legislature and is scheduled to be heard in conference committee next week.
“Thousands of children in Hawaii with autism don’t get treatment,” Green said. “As far as health policy goes … this is the most important bill of the year.”
This isn’t the first time the Legislature has considered requiring insurance companies to cover autism treatment. Lawmakers have introduced similar bills the last four years, but they never passed because of opposition from insurance providers, said Green.
Last year’s bill was amended to require an analysis of the cost of insuring patients instead. Green thinks the insurance mandate will pass this session.
According to the state’s 2014 cost analysis, treatment can cost more than $100,000 annually for children under 6.
Jessica Wong-Sumida, executive director of the Autism Society of Hawaii, said SB 791 would put pediatricians at the front end of autism diagnosis and treatment. If children are diagnosed with autism early, they have a better chance of making it to college and having successful lives, Wong-Sumida said.
Currently 39 states and the District of Columbia have enacted autism insurance reform laws, according to Autism Speaks.
Autism, also known as autism spectrum disorder, is a group of development disorders that children start to develop around the age of 2. The disorders range from Asperger syndrome to difficulties communicating.
One in 68 children have autism, which is five times more likely among boys than girls, according to the Center for Disease Control and Prevention. The CDC estimated that the prevalence of autism has increased roughly 123 percent since 2002.
Lawmakers and advocates are confident that the bill will pass this session.
Green said that he worked with health insurance providers in drafting SB 791, which limits the amount of money and time that insurance companies would have to pay for autism treatment.
“I don’t want to alienate anyone, I want everyone to work as partners,” Green said.
The first draft of SB 791 would have required insurance companies to pay $25,000-$30,000 per year for four years for treatment, depending on the child’s age. In the latest House draft, the payment cap was left blank.
Louis Erteschik, executive director for the Hawaii Disability Rights Center, said that even with a pay cap, the proposed measure would be a huge help for Hawaii’s families.
Most of Hawaii private insurance companies are not opposed to covering autism treatment, a change from previous years, Green said.
Medicaid announced last year that it would cover the treatment.
Last September, the Hawaii Disability Rights Center sued the state Department of Human Services for not providing autism treatment. The suit claimed that children who have autism and are eligible for Medicaid should be provided treatment under a section of the Medicaid Act.
According to the 2014 analysis, covering the cost of autism diagnosis and treatment in Hawaii would increase insurance premiums by $17 to $31 in 2015, which equates to $1.44 to $2.56 per month.
Based on five-year projections, insurance premiums could increase $28 per year by 2019, which is about $2.36 a month.
Under SB 791, insurance companies would be required to cover applied behavior analysis, a positive-reinforcement therapy that helps people with autism improve social behaviors. Several studies have shown that ABA helps children and adults with autism to develop important life skills.
According to the Hawaii study, ABA can cost a family anywhere from $72 to $108 per hour. And, depending on the severity of the disorder, patients may need 500-700 hours of treatment each year.
But Erteschik said that SB 791 could also save the state money.
According to a 2006 study by the Harvard School of Public Health, it can cost about $3.2 million to take care of an autistic person over his or her lifetime. These costs are shared by parents and state agencies.
“It’s not like these kids go away,” said Erteschik. “The state ends up paying big time.”
Right now, the Hawaii Departments of Health and Education provides some treatment services for children with autism, or families can pay out of pocket.
But Beppu says that it’s very difficult to get all of the appropriate services through the DOE. The application process is tedious, and children don’t have access to all types of treatment.
If SB 791 passes, parents would have access to DOH and DOE services, as well as pharmacy services; psychiatric care; psychological care; as well as habilitative and therapeutic services from their health-care providers.