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Parents of children with autism have long advocated for legislation that requires insurance plans pay for the screening, diagnosis, and treatment of autism spectrum disorders, including applied behavioral analysis (ABA for short).  A bill that would have done this (Senate File 2254) failed to pass out of House Commerce Committee again this year. The bill did make it further than before, having passed with huge bipartisan support in the Senate (41-7).  You can see how your Senators voted here.

While this bill did not pass, signficant changes were made to a state program that was created in 2013 to help families whose insurance plans would not pay for these services. The state appropriated $2 million each year to the Autism Support Program to help families, but advocates say the program is too restrictive and too complicated to access.  In the Health/Human Services Budget Bill (House File 2460), the following changes were made to address these issues:

  • Children under fourteen will now be eligible for program funds.  Currently the age limit is nine.
  • Families with incomes up to 500% of the federal poverty level will be eligible for the program.  Current cap is 400%.

  • Requires families with incomes at or above 200% of the federal poverty level to have pay for up to 15% of the costs. Currently that cost-share cap is 10%.

  • Appropriates $2 million for this next fiscal year, but also states that any funds not yet spent in the current fiscal year can be retained.  So unspent program funds will remain, and can be used to fill needs.

  • Requires the Department of Human Services to report on the number of people applying for the program, funding awarded, administrative costs, and recommendations for the program.

In addition, a portion of the funds is used to help provide grants to individuals getting certification in applied behavior analysis (ABA). This was done in increase the number of people providing ABA services in the state, because access wasn't just about coverage but also about provider availability.  The bill changes the program to allow grants to people who receive training in or out of state (currently only Iowa schools eligible).  Iowa residents still have priority in receiving grants.  The program is changed to require that those receiving grants agree to practice in Iowa for a period of time (up to four years), and agree to supervise others that are going through training during this time.

To access program funds, families still must show that they have been denied insurance coverage, and getting that documentation has been very difficult for some families.  The Department of Human Services and autism advocates plan to work on this to find a way administratively to ease this burden.

Requiring insurance coverage for this will be an issue again in the 2017 legislative session, so if this is important to you, make sure you talk to your legislators over the interim.