Autism - What to Do If You Have No Insurance

Having a child diagnosed with autism makes for difficult adjustments in family plans and financial goals. For families with no insurance, the prospect of paying for therapies, doctors, diagnostic testing, medications, and adaptive equipment looms like an insurmountable challenge. However, there is hope and help available to these families that can help take the burden off of excruciatingly high medical and therapeutic costs. For many families without major medical coverage, the first option is to apply for Social Security Disability benefits for their child. These benefits include access to federally funded medical programs like Medicaid.

Unfortunately, getting approval for SSI benefits for a child with autism is not as straight forward as it may seem. While children with classic autism are easily recognized and diagnosed, and therefore are virtually considered disabled by default, other areas of the spectrum are not as clear cut. For example, many children are diagnosed with Pervasive Developmental Delay - Not Otherwise Specified. These children are believed to be somewhere on the autism spectrum, although where in particular is unclear. For these children, professionals may often debate the validity of a spectrum diagnosis. This can make qualifying for disability benefits difficult. Often families must fight to prove adequate disability on behalf of the child. That can sometimes take months or years.

In the meantime, these uninsured children must still undergo treatment and therapies for their autism spectrum symptoms and challenges. However, there are still options available. Virtually every state has a system in place to allow families to apply for Medicaid for their child based on need rather than income. These policies and waivers are known under different names in each state. However, each program works virtually the same. A family applies for Medicaid for the child. If their income is too high and they are denied, filing a petition for a hearing under the state's need-based program or statutes begins the process.

Rather than proving the child is disabled enough to warrant assistance, these waiver programs and regulations require only that the family demonstrate the child's needs versus the family's income. When a child's medical care for their autism diagnosis exceeds certain limits compared to the family's income, the income may be disregarded to allow the child to get Medicaid benefits regardless of parental income. These waivers can often make the difference in the quality of care a child receives. This option is often much quicker than applying for disability benefits and covers the child with the same medical benefits.

Sean L Johnson is a journalist for Health Insurance Buyer a referral service that refers consumers to the insurance carriers that can best fit their wants and needs. Get a free reduce quote today at www.health-insurance-buyer.com

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State Mandates Autism Family Health Insurance Coverage

Many families struggle with autism. Autistic people have a neurological condition that causes them to have trouble with communication and social interaction. The best chance of success for intervention is during early childhood. Various programs increase the probability that a child on the autism spectrum will be able to live a normal life.

Unfortunately, such treatment can cost tens of thousands of dollars annually. The vast majority of parents don't have that kind of money laying around. Most health insurance plans don't cover it, either. That is about to change in one state.

Missouri recently passed a bill that requires many health insurers to cover autism. The legislation, passed by the State Senate, mandates those plans to cover up to $45,000 annually worth of applied behavioral analysis (ABA) therapy for children under the age of 18 from licensed providers. (The bill would also create a new state licensing process, to make sure that the money is not paid to fraudulent specialists.) If signed by the governor, the new rules would become effective on January 1st.

The bill is a boon to families with one or more autistic children, especially since it includes an annual adjustment of the cap based on inflation. However, there are some catches. The law would only apply to those group health insurance plans regulated by the state: mainly those purchases through small- to medium-sized employers. Large corporations who self-insure - paying out their own claims, and only hiring an insurer for administrative duties - are not subject to the mandate, because they are regulated federally. Small businesses with under 50 employees may also get an exemption if they can prove that the requirement caused their rates to rise by over 2.5% over the year before.

What if you are looking to buy individual or family health insurance on the open market? Options that include autism coverage for diagnosis and treatment will be available, but it will not be required of all plans sold in the state.

Proponents predict that Missouri health insurance premiums will only rise by a fraction of one percent, which they consider a small price to pay for so much benefit. After all, early intervention reduces the chance that the state will have to pay to care for people on disability and unable to live or work independently.

Yamileth Medina is an up-and-coming expert on the health insurance industry. She strives to provide balanced facts about health care reform and other issues in an easily understood manner. Yamileth lives in Miami, Florida.

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