Autism mandates are laws that require commercial insurers to cover certain evidence-based treatments for Autism Spectrum Disorder (ASD). The purpose of this study was to review state variability in autism insurance mandates and the benefits they cover and to discuss recommendations for research and policy to improve ASD services across states.
Data were extracted from 2001 to 2020 from all 50 states plus the District of Columbia (N = 51) from policy text. News articles and websites of ASD advocacy organizations were also reviewed to ensure inclusion of the most recent policy changes. Descriptive statistics and heatmaps were used to characterize the autism mandate landscape and visualize variability in benefit parameters across states.
Autism mandates vary greatly in benefit parameters across US states, but there is a common set of benefits that most states have adopted. These include coverage of provider-recommended ASD services except for medical equipment, coverage up to an age limit of 18 to 21, an annual dollar limit of $36,000 with no restriction on the number of hours or visits, no lifetime cap on benefits, and requirement of BCBA® certification or its equivalent for providers of ABA.
There is a need for continued research evaluating the impact of autism mandates and benefit parameters on access to care, service utilization, and clinical outcomes for the ASD population. Stakeholder engagement and understanding the impact of autism mandates on clinical and patient-centered outcomes may provide direction for policy advocacy and public health initiatives.
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American Speech-Language-Hearing Association. (n. d.). State insurance mandates for autism spectrum disorder. Retrieved from https://www.asha.org/Advocacy/state/States-Specific-Autism-Mandates/.
Autism Speaks (n. d.) State insurance reform laws. Retrieved from https://www.autismspeaks.org/advocacy/insurance/faqs-state-autism-insurance-reform-laws.
Baio, J., Wiggins, L., Christensen, D. L., Maenner, M. J., Daniels, J., et al. (2018). Prevalence of Autism Spectrum Disorder among children aged 8 years – Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2014. Morbidity and Mortality Weekly Report,67(6), 1–23.
Baller, J. B., Barry, C. L., Shea, K., Walker, M. M., Ouellette, R., & Mandell, D. S. (2016). Assessing early implementation of state autism insurance mandates. Autism,20(7), 796–807.
Barry, C. L., Epstein, A. J., Marcus, S. C., Kennedy-Hendricks, A., Candon, M. K., Xie, M., et al. (2017). Effects of state insurance mandates on health care use and spending for autism spectrum disorder. Health Affairs,36(10), 1754–1761.
Bilaver, L. A., & Jordan, N. (2013). Impact of state mental health parity laws on access to autism services. Psychiatric Services,64(10), 967–973.
Bouder, J. N., Spielman, S., & Mandell, D. S. (2009). Brief report: Quantifying the impact of autism coverage on private insurance premiums. Journal of Autism and Developmental Disorders,39(6), 953–957.
Buescher, A. V., Cidav, Z., Knapp, M., & Mandell, D. S. (2014). Costs of autism spectrum disorders in the United Kingdom and the United States. JAMA Pediatrics,168(8), 721–728.
Callaghan, T., & Sylvester, S. (2019). Autism spectrum disorder, politics, and the generosity of insurance mandates in the United States. PLoS ONE,14(5), e0217064.
Candon, M. K., Barry, C. L., Epstein, A. J., Marcus, S. C., Kennedy-Hendricks, A., Xie, M., et al. (2018). The differential effects of insurance mandates on health care spending for children’s Autism Spectrum Disorder. Medical Care,56(3), 228–232.
Davignon, M. N., Qian, Y., Massolo, M., & Croen, L. A. (2018). Psychiatric and medical conditions in transition-aged individuals with ASD. Pediatrics,141(Supplement 4), S335–S345.
Douglas, M. D., Benevides, T. W., & Carretta, H. (2017). Analyzing state autism private insurance mandates for allied health services: A pilot study. OTJR Occupation, Participation and Health,37(4), 218–226.
Graaf, G., & Snowden, L. (2020). Medicaid waiver adoption for youth with complex behavioral health care needs: An analysis of state decision-making. Journal of Disability Policy Studies. https://doi.org/10.1177/1044207319897058.
Hansen, S. N., Schendel, D. E., & Parner, E. T. (2015). Explaining the increase in the prevalence of autism spectrum disorders: The proportion attributable to changes in reporting practices. JAMA Pediatrics,169(1), 56–62.
Heidgerken, A. D., Geffken, G., Modi, A., & Frakey, L. (2005). A survey of autism knowledge in a health care setting. Journal of Autism and Developmental Disorders,35(3), 323–330.
Indiana Resource Center for Autism (n.d.). Indiana's health insurance mandate for Autism Spectrum Disorders (ASDs) and Pervasive Developmental Disorders (PDDs). Retrieved from https://www.iidc.indiana.edu/pages/Indianas-Health-Insurance-Mandate-for-Autism-Spectrum-Disorders-and-Pervasive-Developmental-Disorders-PDDs.
Johnson, R. A., Danis, M., & Hafner-Eaton, C. (2014). US state variation in autism insurance mandates: Balancing access and fairness. Autism,18(7), 803–814.
Kennedy-Hendricks, A., Epstein, A. J., Mandell, D. S., Candon, M. K., Marcus, S. C., Xie, M., et al. (2018). Effects of state autism mandate age caps on health service use and spending among adolescents. Journal of the American Academy of Child & Adolescent Psychiatry,57(2), 125–131.
Leslie, D. L., Iskandarani, K., Dick, A. W., Mandell, D. S., Yu, H., Velott, D., et al. (2017). The effects of Medicaid home and community-based services waivers on unmet needs among children with autism spectrum disorder. Medical Care,55(1), 57.
Levy, S. E., Giarelli, E., Lee, L. C., Schieve, L. A., Kirby, R. S., Cunniff, C., et al. (2010). Autism spectrum disorder and co-occurring developmental, psychiatric, and medical conditions among children in multiple populations of the United States. Journal of Developmental & Behavioral Pediatrics,31(4), 267–275.
Mandell, D. S., Barry, C. L., Marcus, S. C., Xie, M., Shea, K., Mullan, K., et al. (2016). Effects of autism spectrum disorder insurance mandates on the treated prevalence of autism spectrum disorder. JAMA Pediatrics,170(9), 887–893.
McBain, R. K., Kareddy, V., Cantor, J. H., Stein, B. D., & Yu, H. (2019). Systematic Review: United States Workforce for Autism-Related Child Healthcare Services. Journal of the American Academy of Child & Adolescent Psychiatry.,59, 113–119.
Molko, R. (2018). Autism matters: Empowering investors, providers, and the autism community to advance autism services. Charleston, SC: ForbesBooks.
National Conference of State Legislatures. (2017). Autism and insurance coverage. Retrieved from https://www.ncsl.org/research/health/autism-and-insurance-coverage-state-laws.aspx.
Rogers, S. J., & Vismara, L. A. (2008). Evidence-based comprehensive treatments for early autism. Journal of Clinical Child & Adolescent Psychology,37(1), 8–38.
Saloner, B., & Barry, C. L. (2017). Changes in spending and service use after a state autism insurance mandate. Autism,23, 167–174.
Soke, G. N., Maenner, M. J., Christensen, D., Kurzius-Spencer, M., & Schieve, L. A. (2018). Prevalence of co-occurring medical and behavioral conditions/symptoms among 4- and 8-year-old children with Autism Spectrum Disorder in selected areas of the United States in 2010. Journal of Autism and Developmental Disorders,48, 1–14.
Stein, B. D., Sorbero, M. J., Goswami, U., Schuster, J., & Leslie, D. L. (2012). Impact of a private health insurance mandate on public sector autism service use in Pennsylvania. Journal of the American Academy of Child & Adolescent Psychiatry,51(8), 771–779.
Shimabukuro, T. T., Grosse, S. D., & Rice, C. (2008). Medical expenditures for children with an autism spectrum disorder in a privately insured population. Journal of Autism and Developmental Disorders,38(3), 546–552.
Stuart, E. A., McGinty, E. E., Kalb, L., Huskamp, H. A., Busch, S. H., Gibson, T. B., et al. (2017). Increased service use among children with autism spectrum disorder associated with mental health parity law. Health Affairs,36(2), 337–345.
Velott, D. L., Agbese, E., Mandell, D., Stein, B. D., Dick, A. W., Yu, H., et al. (2016). Medicaid 1915 (c) Home-and Community-Based Services waivers for children with autism spectrum disorder. Autism,20(4), 473–482.
Wang, L., Mandell, D. S., Lawer, L., Cidav, Z., & Leslie, D. L. (2013). Healthcare service use and costs for autism spectrum disorder: A comparison between Medicaid and private insurance. Journal of Autism and Developmental Disorders,43(5), 1057–1064.
Xu, G., Strathearn, L., Liu, B., O’brien, M., Kopelman, T. G., Zhu, J., et al. (2019). Prevalence and treatment patterns of autism spectrum disorder in the United States, 2016. JAMA Pediatrics,173(2), 153–159.
Zwaigenbaum, L., Bauman, M. L., Choueiri, R., Kasari, C., Carter, A., Granpeesheh, D., et al. (2015). Early intervention for children with autism spectrum disorder under 3 years of age: Recommendations for practice and research. Pediatrics,136(Supplement 1), S60–S81.
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Choi, K.R., Knight, E.A., Stein, B.D. et al. Autism Insurance Mandates in the US: Comparison of Mandated Commercial Insurance Benefits Across States. Matern Child Health J 24, 894–900 (2020). https://doi.org/10.1007/s10995-020-02950-2
- Autism spectrum disorder