What the New Affordable Care Act Provisions Mean For Those With Autism and Related Conditions

The Affordable Care Act, according to the US Department of Health and Human Services, contains crucial health care changes to those with autism or related conditions as well as their families. It's important that we spread the know, so that those affected can understand what these provisions are. The goal of this nationwide effort is to cut healthcare costs and help those without care obtain it.

These health care reforms matter for those affected with autism spectrum disorders because they will face more serious coverage and benefit gaps than others. A lot of families affected by autism spectrum and other related conditions do not get the healthcare they need, and this effort can change that. Or, as critics say, it could possibly only add to the convoluted nature of the healthcare system and its inconsistency among the states.

Some Provisions affecting those with autism/related issues under Affordable Care:

• No child under the age of 19 can be denied coverage by job-based or new individual health insurance plans due to preexisting conditions, including children on the autism spectrum. In 2014 these protections will extend to Americans of all ages.
• Health insurance policies must cover all preventative care expenses: shots, check-ups, immunizations etc.. There is no shared-cost (ie: copay, deductables ect). This includes autism screenings for children between 18 and 24 months (as recommended by the American Academy of Pediatrics). 
• Insurance companies can no longer cap, or set a dollar limit on coverage. Before the ACA, companies held the right to put a limit on the amount of offered coverage, leaving those who exceed this limit to pay out-of-pocket costs. Starting in 2014, no policy can place its own cap. 
• Young adults can now remain on their parents' plan until the age of 26, including those affected by autism/related disorders. For many, this offers peace of mind, as the economy is different and taking on your own health care plan can be difficult without a solid career. 
• Starting in 2014 there will be an expansion of marketplaces for families affected with spectrum disorder to find affordable healthcare
• Starting in 2014, new plans sold in the individual and small group markets will cover "essential health benefits" to make sure that insurance is comprehensive and fully cover realistic needs
• Instead of creating a national standard for autism coverage, a state-level standard will be implemented across America. (Spivey 1). 

Coverage for Autism Treatments

Before ACA, insurers across the country have come up with several mandates on how to manage or guide insurance standards for those with autism. Until now, "essential benefits", or the standard, if you will, has been a matter of statehouse politics. Legislators have created over 16,000 laws regarding health coverage standards for autism. Some state legislators require the coverage of behavioral therapy and other services for autism, but some do not. 

The process of gaining a country-wide requirement by all healthcare policies for coverage of behavioral treatment won't be instant, but it's already in the making. Thus far, 24 states, including Washington D.C., will require insurance carriers that sell policies on their insurance exchange to cover behavioral health treatments as well as preventative care such as behavioral analysis. This includes the following states: Arizona, Arkansas, California, Connecticut, Delaware, Indiana, Illinois, Kentucky, Louisiana, Maine, Massachusetts, Michigan, Missouri, Montana, Nevada, New Jersey, New Hampshire, New York, Ohio, Texas, Vermont, West Virginia, and Wisconsin. Though coverage or implementation may be different from state to state (Spivey 2).

For more information on how the Affordable Care Act will affect coverage for you and your family, or if you have questions regarding the new Health Insurance Marketplaces, or you'd like to know how this new coverage will be implemented in your state, visit http://www.healthcare.gov or call their hotline at 1-800-316-2596. Autism Speaks and the Autism Health Insurance Project are always updating their website with vital information and FAQs regarding the Affordable Care Act and how it may or will affect the autism community (Spivey 2). 

Whether this healthcare reform will truly help our whole nation is still a question to be answered, but at least the ACA is committing to better the system for those affected by autism spectrum. It's important we know what lies in the future, and although our healthcare system can seem convoluted and carelessly executed at times, change is a step in some direction and it's a wildly popular idea that change is necessary. Know the facts, understand the provisions, and fight for what you need.