Autism:  California Law Requires Insurance Coverage for Behavioral Health Treatments for Autism and Pervasive Development Disorder

by PWDF Staff

On October 11, 2011, California Governor Jerry Brown signed into law SB.946 which explicitly requires health plans and insurers to provide behavioral health treatments for autism and pervasive development disorder.

The bill is modest in scope, and remains in effect until 1/1/2015 when it will be repealed unless another statute is enacted to extend it. Still, it finally requires health insurance companies to acknowledge that autism, like other mental illnesses, is a medical disorder requiring medical treatment.

The bill was supported by statewide and national autism advocacy organizations, families and a wide range of disability advocacy groups who argued that behavioral intervention treatments are medical or health services that should be covered by health plans and health insurance the same as other treatments and services. They argued that denying such coverage harms their children at a crucial stage of lives and represents blatant discrimination due to their disability.

The bill was strongly opposed by private health insurance groups who argued that the bill would raise premiums for everyone in their plans - and also that behavioral treatments should remain the responsibility of schools and the State funded programs for people with developmental disabilities coordinated through the California’s 21 non-profit regional centers.  

As reported by the national advocacy organization Autism Speaks, the prevalence of autism in children has risen to 1 in 110, including 1 in 70 boys. Estimates of the annual cost of autism to the nation have ranged as high as $90 billion. The number of California children with autism has not been calculated precisely, but estimates range at 30,000 children. Thousands of California families, in the absence of insurance coverage, have been forced to pay out-of-pocket or rely on taxpayer-funded programs for behavioral health treatments, which can cost $50,000 a year or more. This year alone, laws have been enacted in Arkansas, Virginia, West Virginia and Rhode Island; and a bill passed this summer by the New York Legislature awaits Gov. Andrew Cuomo’s signature.

To help guide parents and health care consumers, Autism Speaks through its Autism Votes Initiative  has already prepared and posted a list of Frequently Asked Questions.

PWDF Profile

Who We Are

People With Disabilities Foundation is an operating 501(c)(3) nonprofit organization based in San Francisco, California, which focuses on the rights of the mentally and developmentally disabled.

Services

Advocacy: PWDF advocates for Social Security claimant's disability benefits in eight Bay Area counties. We also provide services in disability rights, on issues regarding returning to work, and in ADA consultations, including areas of employment, health care, and education, among others. There is representation before all levels of federal court and Administrative Law Judges. No one is declined due to their inability to pay, and we offer a sliding scale for attorney's fees.

Education/Public Awareness: To help eliminate the stigma against people with mental disabilities in society, PWDF's educational program organizes workshops and public seminars, provides guest speakers with backgrounds in mental health, and produces educational materials such as videos.

Continuing Education Provider: State Bar of California MCLE, California Board of Behavioral Sciences Continuing Education, and Commission of Rehabilitation Counselor Certification.