Battle Over Insurance Coverage For Kids With Autism Brews At Capitol

Tuesday, April 12th 2011, 2:45 pm
By: News 9

Amy Lester, Oklahoma Impact Team

OKLAHOMA CITY -- Year after year, families fight to get health insurance coverage for therapy they say their kids need. Every year the legislature disappoints them and this year is no different.  It looks like the legislature won't consider the issue of providing coverage for children with autism.

"When I hear about the legislature delaying for another year, all I think about is in terms of who's kid is regressing during these twelve months," said Juliet Burk, mother and advocate for Nick's Law.

Juliet Burk wants the legislature to vote on Nick's Law. The bill would force health insurance companies to cover all therapy for kids with autism, including ABA, behavioral therapy.

"Autism does not go away when you don't treat it, it just gets worse and the kids grow up and instead of a 2 year-old with behavioral problems, you've got 20 and 30 year olds with behavioral problems and the state pays for that," said Burk.

Burk knows the benefits of behavioral therapy all too well. Both of her sons were diagnosed with autism. Her family moved to New York so the kids could get the therapy they needed. The school district and insurance picked up the tab. One of her sons started therapy at just over two-years-old, the other at nine months. Her younger son is no longer diagnosed with autism and her older son's case is extremely mild. She credits the intense therapy at a young age for their recovery.

"Until the insurance companies get on board with the schools, and go hand in hand, to provide the kids what they need, then you're just going to have kids without hope all over the state which is what you've got now," said Burk.

Twenty-six states currently have autism related insurance mandates. Representative Mike Brown wants Oklahoma to become number 27. That's why he wrote Nick's Law.

See map of states and current autism insurance mandates.

"We always want to be like the rest of the nation. Lets be at the forefront here and take care of our kids," said Brown.

Read Brown's bill.

His original version of Nick's Law called for an insurance mandate that voters would have to approve. It would force insurance companies to cover all autism related therapy, including occupational, speech, physical and behavioral, ABA. But, his bill was not heard in committee and when he tried to get the Speaker of the House Kris Steele to allow a vote on the floor, he refused.

"I know there's strong support for it with most legislators, across the aisle, there's strong support for it. But, the powers that be right now, I'm not speaking for why, it's just not happening," said Brown.

By powers that be, he's talking about Speaker of the House Kris Steele.

"I do not favor this particular proposal," said Steele.

Instead, Steele wants to give his autism bill, that passed two years ago, time to work.

"I really believe we ought to give the pilot program an opportunity to work before we do anything that's going to increase the cost of health insurance for all Oklahomans," said Steele.

Read Steele's bill

Steele's bill expanded an ABA therapy program called Early Foundations. It now can provide services to up to 12 additional kids. It also calls for ABA training for Sooner Start staff who work with kids under three at home. Only eight people are going through training to serve 165 kids in the state. A study of this technique will also start soon, involving 30 kids. The Speaker's plan clearly won't help every child receive this normally costly therapy.

"We want to be able to determine if these particular services have medical value and actually help children in our state that battle autism," said Steele.

He also points out that coverage for occupational, speech and physical therapy are already available.

"Now there's this autism benefit, that individual families can purchase if they would like to do so," said Steele.

The Oklahoma Impact Team found that's not exactly the case. Steele's referring to Blue Cross Blue Shield of Oklahoma, which announced two years ago it was adding an autism benefit. But, that coverage is only available with group plans, not individual plans, so you can't buy it on your own. If you do have Blue Cross at work, your employer may decide to carry the autism coverage or may not. Either way, there's no coverage for ABA, behavioral therapy, at all.

Blue Cross Blue Shield of Oklahoma's announcement of autism coverage

The OIT checked with multiple private companies and the state employees' plan, all offer comparable or far less coverage.

That's one reason why Juliet Burk, whose kids benefited from autism therapy, said it's time for the legislature to take action.

"Some little kid, somewhere in this state is getting worse, I don't think we can afford to delay.  I don't think it is ethical to delay," said Burk.

Speaker Steele said he does not plan on letting legislators vote on Nick's Law this session.