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Friday, October 29, 2010

Expert Q&A: My child has autism

Elaine Saly

Health Policy Analyst

Many of you have sent in questions about how the new health care law will affect you and your family. We’ve compiled answers for select questions to our experts in a short series to help you navigate changes to the health care system. Here's the latest:    

Question: My 16 year-old son has autism. He currently receives survivor benefits from Social Security. These will end when he's 18; however, his autism won't. Will health reform provide any services or support for our autistic children as they become adults?

Answer: Yes, your son and other young adults with autism will benefit from many provisions of the Affordable Care Act. The new law provides new protections for people with developmental disorders, ensures that mental health services are covered, and expands community-based supports for people with disabilities or chronic conditions who need long-term care.

Consumer protections: Currently, many people with developmental disorders face discrimination from private insurers based on their “pre-existing conditions.” Beginning in 2014, the new law will prohibit health insurers from denying coverage to any American because of a pre-existing condition, such as autism, and will stop insurers from excluding coverage of services for these conditions. These protections are already in effect for children under the age of 19. Starting in 2014, insurers will also be prohibited from charging people higher premiums because they have a pre-existing condition. In addition, the Affordable Care Act stops insurance companies from imposing lifetime or annual limits on the dollar amount of health benefits that they cover. The prohibition on lifetime dollar limits on coverage is in effect now, and the ban on annual limits will be phased in until the limits are completely prohibited in 2014. These new protections will ensure that people with developmental disorders have access to reliable and comprehensive health coverage.

Comprehensive benefits: Under the law, all new health insurance plans (sold on or after September 23, 2010) must cover certain preventive services, including autism screenings and developmental assessments for infants and young children, at no cost to consumers. Starting in 2014, plans sold through the new health insurance exchanges must cover mental health services, including behavioral health treatment, and they may not impose more restrictive coverage limits for these services than they do for physical health services.

Long-Term Services and Supports: People with developmental disorders or chronic health problems who require long-term services and supports will also benefit from the Affordable Care Act. The law will expand access to long-term care delivered in peoples’ homes and communities (instead of in institutional settings like nursing homes) by allowing states to increase the income eligibility levels for these programs. It also lets states tailor their home- and community-based service programs to meet the needs of certain populations, like children with autism or adults with traumatic brain injury. Additionally, the Affordable Care Act prohibits states from limiting the number of people who can get community-based services and supports and stops states from keeping people who need these services on waiting lists. The law also provides states with new federal funds to assist with the cost of personal care services for individuals with developmental and physical disabilities.

The Affordable Care Act is a huge step toward improving equality in access to health care for people with developmental disorders. As a result of the law, people with behavioral and mental health needs will finally be treated fairly by insurers and will be guaranteed access to affordable and comprehensive coverage, and those needing long-term services and supports will be able to live more independently.