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Bill would mandate autism coverage in Georgia

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Advocates are expecting a fight over Georgia legislation to require insurance coverage for early intervention care for children with autism.

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Melissa and Arturo Solares sit with their children, Carmen and Arturo. The Solares' paid out of pocket for intensive therapy for Arturo, who is now in a regular preschool.  JIM BLAYLOCK/STAFF
JIM BLAYLOCK/STAFF
Melissa and Arturo Solares sit with their children, Carmen and Arturo. The Solares' paid out of pocket for intensive therapy for Arturo, who is now in a regular preschool.

But this time they’re hoping to win.

Ava’s Law, which state Rep. Ben Harbin, R-Evans, plans to file this week, would mandate insurance companies pay for expensive, intensive services for children diagnosed with autism.

Currently, insurance companies in Georgia won’t pay for specialized therapy, including Applied Behavior Analysis, for children with autism. Parents must either accept the diagnosis and rely on minimal special needs services from the public school system, or pay for therapy that can improve the child’s abilities at an estimated $30,000 to $50,000 per year.

“It’s devastating for parents to come up with that kind of money,” said Judith Ursitti, regional director of state advocacy for Autism Speaks. The “window of early intervention” for children with autism make it urgent that the therapy begin before about age 6; its duration, and total cost, depends on the severity of the autism, she added.

There’s little argument the therapy works, Harbin said. The problem is getting insurance companies to agree to pay for it.

“It is a mandate, and those get such a bad connotation,” Harbin said. “But insurance companies don’t provide autism coverage in this state. Other states do.”

Russell Childers Jr., of Americus, Ga., chairman of the Government Affairs Committee for the Georgia Association of Health Underwriters, said the professional organization wouldn’t favor such legislation.

“We don’t really have a position on the autism mandate,” Childers said. “We have a position on mandates in general.”

Federal health reforms are expected to further increase the cost of insurance coverage, he said, and the industry opposes mandates that could add to that expense.

Still, supporters of the legislation take hope from its passage in other states, including South Carolina. In 2007, the legislature overrode then-Gov. Mark Sanford’s veto to enact Ryan’s Law, which mandates autism coverage.

Successful implementation of that law gives supporters of Ava’s Law reason to believe they’ll have more success than a 2009 attempt that failed in Georgia.

“I really do believe in this legislation,” said Melissa Solares of Evans. “We need help. You go five miles away (to South Carolina), and these children are getting the services they need.”

Solares and her husband paid out of pocket for intensive therapy for her son, Arturo, now 5, when their health insurance wouldn’t provide coverage after his diagnosis of autism.

As a toddler Arturo was non-verbal and not potty-trained, and seemed destined for a life of special education classes, Solares said.

Since the therapy, he’s now enrolled in a regular preschool. “We changed the path of his trajectory,” Solares said.

“I feel like my son’s life depends on this,” Solares said. “It’s important that these children in Georgia have a chance.”

An analysis of other state’s programs show that paying for the early intervention therapy would cost policy-holders just 33 cents per month, Harbin said. In return, taxpayers wouldn’t face years of paying for special education classes for untreated autistic students.

“We know if we can do the early treatment and we can get them back into normal range classes, then we don’t have to spend all additional money through the school system,” Harbin said. “Really, you’re making an investment. What we’re doing is we’re saying this should be covered by insurance companies because otherwise in Georgia there’s nowhere for these people to turn.”

Ava’s Law is named for Ava Bullard, an 8-year-old Lyons, Ga., girl whose mother, Anna, has crusaded for the insurance coverage since her daughter was diagnosed with autism.

Like Solares, Bullard was told to expect to place her child in special education classes when she sought answers for Ava’s distant, non-verbal behavior.

Instead, she paid for the Applied Behavior Analysis treatment for Ava and, like Arturo’s case, saw “dramatic improvement,” Bullard says in a video being used to promote the legislation.

Ava is now in regular third-grade classes, Bullard says.

“Ava’s Law is as simple as children with autism in the state of Georgia being able to receive coverage from their insurance companies just like children with autism in the surrounding states,” Bullard says in the video.

Changes ahead from the federal Affordable Care Act, however, make adding mandates a bad idea, Childers said.

“There are lots of reasons we should have this coverage and that coverage on health insurance,” Childers said. “But we don’t feel like it makes sense to add things to the federal law before we see what the federal law is going to cover and how much it’s going to cost.”

While cost is a huge factor, Harbin contends that funding early care is a better option than warehousing autistic students in taxpayer-funded special education classes.

“If they’ll make this investment today, it’ll actually save them money down the road, and it’ll save taxpayers money down the road,” Harbin said. “It’s the right thing to do.”

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resident
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resident 02/11/13 - 12:30 pm
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ABOUT TIME!!!!!!

I guess he finally buckled under pressure from those of us that pay out of our pockets for this stuff. It is not some fluke or joke this is to help them become normal citizens some day and not be a drain on the government systems. I for one will stand in line and fight for this one.

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