Challenges of Autism
12:00 am
Thu November 11, 2010

Insurance Law Could Mean New Options for Children With Autism

This week, NHPR correspondent Sheryl Rich Kern has been looking into the challenges schools face when teaching children with autism.

The parents obviously face challenges too. Providing the therapy some children need costs a lot of money and time. But come January 1st, relief is on the way. 

In our week-long series Challenges of Autism, NHPR correspondent Sheryl Rich Kern looks into the new legislation.

The standard treatment for autism when kids are young is something called applied behavior analysis or ABA.

Doctors recommend at least 25 hours of it a week. But autism specialist Dr. Stephen Mott at Dartmouth-Hitchcock says most kids don’t get that.

Mott: "My understanding in my short time in New Hampshire is that the best I’ve seen is 25 hours. But the average is five hours."

Using this therapy takes a huge commitment. Of time. And money. Michelle Abbott of Hudson can attest to that. She’s the mother of two young girls. Both have an autism spectrum disorder.

Her older is Sarah. She was 14 months old when the doctor diagnosed her. And within a few days, life at the Abbotts became anything but routine. A constant pool of therapists — occupational specialists, speech pathologists — began coming to the house. 

Abbott: "They taught me how to teach my child. They taught me how to communicate with my child. They helped me into the school system. Three years old. She was only a baby. For a parent, it was hard."

And it was expensive.

Abbott: "It’s amazing the amount of money that is spent. I know my first year especially with all the medical issues, I think we spent just on one daughter, $30,000 out of pocket with all her medical issues and specialists and doctors and different therapies outside of school that she needed."

"Ready, ready, point to the pilot."
Sarah: "Pilot, luggage"

Sarah who’s now six, bangs her feet against the legs of a chair as a teacher’s aide asks her to match phrases with pictures. It’s a repetitive process that gets a child to perform simple tasks that for most children come naturally.

(sound of teacher saying "coloring, nice job")

Parents often find themselves pushing for more hours because the therapy seems to work.

Murphy: "47 percent of children who receive that recommended level of intensity will go on by kindergarten to be very similar to their peers."

That’s Kirsten Murphy. She’s the director of the New Hampshire Council on Autism Spectrum Disorders.

Murphy: "And another 40 percent will make significant progress. An 87 percent positive outcome rate is better than most cancer treatments that I know about. That has an incredibly long-term financial benefit to the taxpayers in the state of New Hampshire."

So why does Murphy mention the benefits to New Hampshire taxpayers? Because in many cases, schools are paying for the therapy. And kids who get treated early will need fewer social services as adults.

Thanks to legislation passed this year called Connor's Law, as of January 1st, insurance carriers will have to cover the 25 hours of ABA therapy.

But that doesn’t mean everyone with a doctor’s prescription will receive it.

Dartmouth-Hitchcock’s Dr. Stephen Mott: "The biggest stumbling block we’re going to have is that in the state of New Hampshire there’s a limited number of certified number of applied behavior analysts who really can help these children."

New Hampshire is the 22nd state in the country to reform insurance coverage for people with autism. But not every family with health insurance will benefit.

The new law applies only to state-regulated insurers. Children whose parents work for large employers with self-funded insurance programs are not covered. And for those who are, state insurance officials expecteexpect premiums will increase between .2 and .4 percent.

Children who benefit from Medicaid also won’t get help from the new law. Kirsten Murphy of the New Hampshire Council on Autism Spectrum Disorders:

Murphy: "I don’t think it reflects well on New Hampshire to have a benefit that middle class children can have and poor children on S-Chip can’t have. We certainly need to do something about that."

The New Hampshire Council on Autism Spectrum Disorders is working with legislators to expand coverage to other markets.

But with a state budget that’s already tight, Council members aren’t optimistic.