PHILADELPHIA (KYW Newsradio) — Starting next year, autism treatment in Pennsylvania will be covered by insurance on par with other mental health support and services. That was the word from Gov. Josh Shapiro on Wednesday, along with leaders from Drexel University and the Eagles Autism Foundation.
Beginning Jan. 1, Shapiro says, insurers will be required to provide consistent, fair coverage for autism services and support for the more than 55,000 Pennsylvanians with autism. The change is a welcome one for autistic adults like Michael Alos, who wasn’t diagnosed until he was 50.
“As a child, I had all the typical autistic traits, such as difficulty with friendships, communicating with others and understanding the social norms in school. I also fell behind and struggled academically,” he recalled.
“As I grew into an adult those same relationship and communication difficulties followed me. The impact of falling behind in school started to plague me as I moved to college. The communication difficulties affected my marriage.”
Alos says insurance to cover support services and other needs can be expensive — or outright unavailable. “There is ongoing therapeutic care that one might require to reduce the symptoms that interfere with daily functioning and quality of life,” he explained.
“The earlier that autism is detected and the more treatments that are available the better the autistic person can benefit from therapies, support and ongoing school accommodations.”
But for too long, those needs have not been consistently covered by the insurance industry, according to Shapiro.
“For some time now, autism has been recognized as a mental health condition by researchers and doctors …. Unfortunately, this definition hasn’t been consistently applied across insurance companies,” he said.
“Our federal government has frankly failed to establish nationwide standards, resulting in families here in Pennsylvania oftentimes being shut out of coverage or being unable to afford vital services that their loved ones need.”
According to Pennsylvania Insurance Commissioner Michael Humphreys, categorizing autism as a mental health benefit will have many positive impacts for Pennsylvanians with autism, regardless of age.
“Generally this means that health insurers may not charge higher deductibles or copays for autism services,” he said. “It means that health insurers may not cover fewer autism service visits than they would for comparable health conditions and it means that health insurance policies that cover individuals and that cover fully insured employers may not impose annual or lifetime dollar limits on autism.”
People who need support dealing with insurers or who want to report problems can contact Pennsylvania Insurance Department’s Consumer Services online or by phone at 877-881-6388. More information on the Shapiro administration’s support for Pennsylvanians with autism is also available online.