Latest Update on Status of HB8 Autism Insurance Coverage and Outlook for 129th General Assembly - Click Here
For information on the federal Pre-Existing Condition Insurance Program, click Here.
For information on the Pre-Existing Condition Insurance Program in Ohio, click Here.
Background
Autism Insurance Coverage Legislation in Ohio
Latest Information
Action Alerts
Get Involved
Sign Up for Action Alerts and to Provide Information
Help Educate Your Legislators
Make Your Voice Heard!
News Items
General
Ohio
Other States
Health Insurance Guides and Information for Ohio Stakeholders
Useful Insurance Information
National Insurance Issues
Background
There is no required private insurance coverage for the diagnosis or treatment of ASD in Ohio. Some private insurance companies do provide coverage for autism treatment and autism related services including occupational therapy, physical therapy and speech language therapy.
The State of Ohio, through different Medicaid waivers and Medicaid card services, pays for certain autism services. Services for children ages 0-3 are covered through the Ohio Department of Health Help Me Grow Program and ODDD Early Intervention Services. Services for children ages 3+ and adults are delivered through ODDD. Limited services are covered through the Ohio Department of Health, Bureau of Services for Children with Medical Handicaps (BCMH).
BCMH provides funding for services, diagnosis and treatment of children with medical conditions that are medically eligible. For example, children with ASD sometimes have other medically eligible conditions like seizures, hearing loss, and gastrointestinal problems, which can be covered by BCMH. Additionally, parents can obtain a time-limited diagnostic enrollment that will pay for autism testing and assessment services. Some autism treatments are available as covered services under Medicaid waivers administered by ODDD or the ODJFS - although there are waiting lists for these waivers numbering in the thousands.
Because Ohio law does not require insurance coverage for ASD treatment, families that do not qualify for Early Intervention Services and/or ODDD services pay for services out of pocket, often tens of thousands of dollars per year. Families that cannot afford to do so may go without crucial interventions.Bearing this burden, and navigating the very complicated system of state-funded coverage results in enormous strain on families, often resulting in divorce and even bankruptcy. Autism Insurance parity was a recommendation of the legislatively created Ohio Autism Taskforce. To read the complete report of the taskforce, Click HERE To read the 2007 ODDD Status Update on the OAT Recommendations, Click HERE . ASO has taken on the OAT report as a blueprint for advocating for services for persons with autism and their families in Ohio. Autism Insurance Parity is a top priority.
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* Habilitative or rehabilitative care (which would include therapies like Applied Behavior Analysis)
The Ohio Legislative Services Commission has prepared a Fiscal Note and Local Impact Statement of H.B. 170. HB 170 was the predecessor of HB 8 in the 127th General Assembly. Click HERE to see the fiscal note: Fiscal Note and Local Impact Statement of H.B. 170
The Autism Society of Ohio is currently working with a consortium of interested parties on the autism insurance issue in Ohio.
Get Involved
Sign Up for Action Alerts, Get to Know your Legislators!
Issues that affect individuals with autism, their families and those who work with them - like autism insurance coverage - regularly come before the Ohio General Assembly. It is important to educate legislators about the impact those issues have.
If you are willing and/or able to:
*provide a story related to autism services from your heath insurance company
*provide a letter of denial from your insurance company
*provide a copy of your health insurance policy that contains language specifically excluding autism
*testify in Columbus at committee hearings
*write letters to legislators
*come to the statehouse to support others testifying or for rallies
*meet with legislators, either in Columbus or your local area
We need your help!
Join the Autism Society of Ohio's Ohio Autism Advocacy Network
The Ohio Autism Advocacy Network is a network of constituents in each of Ohio's legislative districts that act as a resource for their legislators on autism issues. The Autism Society of Ohio provides information, training and detailed action alerts to constituent advocates to help them better advocate with their legislators. Want to be a part of the Network? Please provide the following information via email: Name, address, city, zipcode, phone, email address, state representative and state senator. Cut and paste the items that you can help with from the above list into your email and send to
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please put ADVOCACY NETWORK in the subject line. If you wish to participate, but would like to remain anonymous when working with legislators, please still send us your contact information so we can alert you as to when your help is needed - and you can respond to your legislators anonymously. Just note with your contact info that you would like to remain anonymous.
If you would like to receive email alerts on other autism related topics, click "HOME", and register in the "Login" section on the upper right corner of the page.
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Help Educate Your Legislators
Many legislators do not understand or know much about autism. Nor do they understand the problems families face trying to get medical treatments for their loved ones with autism. In order to get Autism Insurance Parity passed in Ohio, we will need to educate our Ohio Legislators! Please contact your legislators and provide them with one of the "Frequently Asked Question" sheets below. Not sure of who your state legislators are - Click HERE and follow the directions under "Locating Legislators".
ASO has participated in an Autism Caucus in both the Ohio House and the Ohio Senate. All legislators were provided with information about autism. But it is important for constituents to make contact with their specific legislators to make the issue of autism personal. Download any of the information sheets listed to provide autism information to your legislator.
Information Sheets:
ASO: One Page Autism Brochure Click HERE
ASO: Autism Facts and Stats Click HERE
ASO: Frequently Asked Questions, Facts about Autism Click HERE
ASO: Frequently Asked Questions, House Bill 8 Click HERE
Talking Points on Autism Insurance Coverage Click HERE
Autism Speaks: Arguments in Support of Private Insurance Coverage of Autism-Related Services Click HERE
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Make Your Voice Heard!
What can you do NOW to help in this effort?
A few suggestions:
- Meet with your legislators when they are in district (usually Mondays and Fridays) and share information about autism. Be brief and positive!
- Use the information listed above to help educate your legislators.
- It is a legislator's job to represent the interests of his/her constituents, so make your voice heard! If you need help, there are plenty of resources out there.
- For a course "Making Your Case" from Partners in Policymaking for effectively communicating with your legislators and others, Click HERE.
- For a "Making Your Case" Handbook from the Minnesota Governor's Council on Devleopmental Disabilities (generic and useable for Ohioans), Click HERE.
- Click HERE for Do's and Don'ts from the Disability Policy Collaboration
News Items
General
2009-01-11 The San Francisco Chronicle: California parents sue insurance company over autism coverage Click HERE
2008-10-17 CNN.com Parents press for autism insurance coverage Click HERE
2008-09-16 Boston Globe: Push on for insurers to share autism costs Click HERE
2008-07-08 LA Times: Who pays for autism treatment? Click HERE
2008-05-08 Chicago Tribune: Parents of children with autism are often invisible casualties Click HERE
2008-04-27 Wall Street Journal: Hard Choices About a Child's Special Needs Click HERE
2008-04-02 Medical News Today: Autism: Out-of-pocket Expenses, Missed Income Opportunity Levy Double Burden On Families Click HERE
2008-04-01 CNN: Mom Wins Fight for Autism Insurance Click HERE
2008-04-30 Stateline.org: Parents turn to states for autism help Click HERE
2008-03-24 ABC News: Insurance vs. Autism: For Parents, Insurance Is a Personal Fight Click HERE
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Ohio
2010-09-16 The Athens Post: The Growing Spectrum Click HERE
2007-11-08 Autism Bulletin: Ohio House Takes Up Autism Insurance Parity Bill Click HERE
2007-09-06 Columbus Dispatch: Lawmakers Push to Cover Autism in Health Plans Click HERE
Health Insurance Guides and Information for Ohio Stakeholders
* Choosing and Using a Health Plan: A Consumers's Guide Click HERE
* Ohio Health Care Safety Net - A Description of Public and Private Programs Click HERE
* Appeals Process: What Happens if Your Insurance Company Says No Click HERE
* Shopper's Guide to Health Insurance & HMOs Click HERE
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Useful Insurance Information
* What is the Health Awareness Portfolio? Click HERE
* Other Strategies for Funding Click HERE
* Letter of Medical Necessity: What Providers Need to Know Click HERE
* Insurance Communications Log Click HERE
(Information provided by the ASA-Autism Society of Colorado)
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Insurance Coverage-on-a-Budget Links (some links provided by TACA)
*Insurance Pays for What? Click HERE
*Insurance for Beginners Click HERE
*How to Start Working with Your Insurance Company Click HERE
*Appealing an Insurance Denial Click HERE
*What is ERISA-Employee Retirement Income Security Act? Click HERE
*Health Savings Accounts Click HERE
*Tax Strategies for Parent of Children with Special Needs Click HERE
*Medicaid in Ohio Click HERE
*Who Pays for What? Click HERE
*Definitions Relating to Insurance Click HERE
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National Insurance Issues
The new Health Care Reform bill passed by Congress in March of 2010 is generally good news for families with a loved one with autism. Key features affecting individuals with autism include:
- oProhibited from excluding coverage based on pre-existing conditions
- oPrevented from selectively refusing to renew coverage;
- oNo longer be able to charge people different premiums based on their health status, gender or occupation;
- oStandardized annual out-of-pocket spending limit would be established so that no family would face bankruptcy due to medical expenses
- oAnnual and lifetime benefit caps are prohibited
- o“Habilitative” and“maintenance services” are be covered o
- Coverage of “Behavioral health treatments,” such as ABA therapy, are be covered
- oBenefits extended for dependants up to age 26 o
- High Risk Insurance Pool –uninsured Ohioans with pre-existing conditions www.ohiohighriskpool.com
For information on how health care reform will affect you, visit: www.healthcare.gov
For information from Ohio, visit: www.healthcarereform.ohio.gov
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