The Path to Autism Coverage

Michigan mandated under Public Act 101 of 2012 that commercial and non-profit insurance carriers provide autism coverage. Michigan State University is a self-insured provider and does not fall under the stipulations of the new law. APA, along with the Coalition of Labor Organizations (CLO) on campus is advocating within the Joint Health Care Committee with the University to provide coverage for families with children with autism.

 

The new law established a tiered system that covered Autism Diagnosis, Pharmaceuticals, Psychiatric, Psychological, and Therapeutic services (Speech, Occupational, Applied Behavior Analysis, and Physical therapies; and social workers).

  • Children up to 6 years of age get up to $50,000.00 annually.
  • Children 7 through 12 years get up to $40,000 annually
  • Children 13 through 18 years get up to $30,000 annual

 

The Legislature appropriated funds for self-insured employers like MSU by creating an Autism Reimbursement Program. The fund was initially appropriated $15 million dollars and will have additional annual appropriations. As of January 2012 only 2 claims had been processed. The CLO is working with MSU to sign up for the Autism Reimbursement Program so that union members can have immediate coverage for their children. Claims that have an autistic diagnosis currently are denied by the third party administrator MSU contracts to process the medical claims, Blue Care Network and Blue Cross/Blue Shield of Michigan because MSU is exempt from the autism coverage law. The University would need to agree to cover autism related medical claims.

 

MSU has an expert on autistic medical coverage in Dr. Jane Turner, a professor at the College of Human Medicine, Department of Pediatric and Human Development. Dr. Turner is on the Governor Snyder’s newly created Autism Council charged with overseeing Michigan’s Autism Spectrum Disorders (ASD) State Plan. http://www.michigan.gov/snyder/0,4668,7-277–281766–,00.html. Having a leader in the field on campus will hopefully assist MSU in agreeing to add autism coverage to the self-insured plan.

 

Josh Wortz, APA member and autism activist, has been working to connect staff members on campus who are affected by MSU not covering these claims.

 

“For my family, having coverage would mean that my family could afford therapeutic services that would help my son gain the skills that will help him be successful and independent,” said Wortz.

 

If your family would benefit from MSU covering autistic claims and related behavioral, speech and occupational coverage, please contact the APA office at (517) 353-4898 or email msuapa@msu.edu. It is important the University hear the voices of the families whose children need this coverage to improve the quality of their life and give them adequate medical coverage.

 

For more information:

 

1) Senate Fiscal Agency Analysis of PA 101

http://www.legislature.mi.gov/documents/2011-2012/billanalysis/Senate/pdf/2011-SFA-0414-N.pdf

 

2) Frequently Asked Questions about PA 101

http://www.michigan.gov/documents/lara/LARA_Autism_Fund_FAQ_FINAL_400157_7.pdf

 

3) Autism Reimbursement Program information

http://www.michigan.gov/lara/0,4601,7-154-62954-287554–,00.html

 

4) For additional information and resources, families may want to contact Autism Alliance of Michigan, autismallianceofmichigan.org or Autism Speaks, www.autismspeaks.org.