Autism Therapy Coverage – USA & Australia
Autism is a lifelong neurological disorder characterised by impairments in communication, socialisation, and restricted patterns of interests and behaviours. According to the CDC up to 1 in 80 children. Autism impacts on the child (the major cause of learning difficulty), the child’s family (limited vocational and social opportunities, very high rates of parental depression and marital separation, social disadvantage for siblings) and the community (the cost of autism to the Australian community has been estimated at $7 billion per annum).
While there is no cure for autism Early Intervention programs targeting the crucial early learning years can dramatically improve the performance of these children, setting them on the path to mainstream education and eventual independence.
So what is being done about it? Check out a comparison of the situation in Australia and the United States.
The Australian Commonwealth Government’s Best Practice Guidelines state that “A program needs to be of at least 20 hours per week over an extended period of at least two years”. This equates to 1000 hours per year for 2 years. Despite these guidelines only a handful of families can afford to access this amount of therapy.
Isn’t this fully covered by Government Funding (Medicare) similar to other health issues like cancer? No. Currently the Helping Children with Autism package falls short of providing children with best practice early intervention. Whilst the funding certainly provides universal access to at least some early intervention, for most children the hours provided fall far short of government recommendations. HCWA package plus medicare rebates cover for many families 10% of their funding needs at best.
Doesn’t Private Health Insurance cover most of the cost then? No. While most of the Health Insurance providers as part of the extra’s packages include some coverage for services provided by allied health professions that work with children with Autism like psycholoogists, speech pathologists and occupational therapists they are capped. The top extras cover usually has a limit of less than $1000 a year for all of these services combined.
Is something being done to change this? No There is no insurance reform currently being spoken of within the political agenda let alone enacted.
So what happens? Parents fund it if they can … some dip into their superannuation or simply the child does not get the therapy they need. It is really that simple.
Please support organizations such as 1000 hours that are working to improve the funding for services for children with Autism
Nationwide, few private insurance companies or other employee benefit plans have voluntarily covered autism therapies. In fact, most insurance companies designate autism as a diagnostic exclusion, meaning that no autism-specific services are covered.
Autism Votes, an initiative of Autism Speaks, is working to change state insurance laws to require private health insurance policies to cover the diagnosis and treatment of autism spectrum disorders.As a result of their efforts
- 23 states have enacted Autism Insurance Reform to require health insurance coverage including ABA (Applied Behaviour Analysis).
- 4 states have passed legislation that is awaiting to be signed by the state governor
- 10 have endorsed autism insurance reform bills
- 9 have autism insurance reform bills pending introduction or endorsement
Most of the legislation require health plans subject to cover evidence-based, medically necessary autism treatments and contains no age or dollar caps. While there is still alot of work to do this is just amazing. If you live in the US please visit Autism Votes and contact your legislators and governors and show your support for people with autism.