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Deal wants state insurance to cover autism treatment

Local residents feel move is step in right direction

POSTED: January 16, 2014 11:45 p.m.

ATLANTA — Gov. Nathan Deal has proposed the state employee health plan cover treatment of autism, a move applauded by advocates who say early intervention can improve behavior and quality of life.

In his budget proposal announced this week, Deal said he would set aside $2.4 million for the coverage. Dozens of other states have passed legislation compelling insurers to provide for the treatments, which can be costly but effective. Research has shown early intervention treatments can prevent or greatly minimize some of the associated disabilities of autism.

“Considering autism is a neurological disorder, it should be covered under any health plan,” Haynes Kaufman, a teacher at Gainesville Middle School who has a 15-year-old autistic son, told The Times. “It should never have been excluded from any health plans.”

Kaufman, however, won’t benefit from Deal’s proposal because her child is already covered under a Medicaid waiver.

“It’s a day late and a dollar short for us,” she said, but added that she hopes other public school teachers she knows who also have autistic children will be able to get the coverage they need.

Jill Klink, a contracted speech pathologist for Gainesville City Schools who has a 7-year-old autistic son, said the proposal is an acknowledgment by the state government that autism has become an epidemic. Though she already receives coverage for her son, she said she believes the proposal is “definitely a first step” to requiring all insurers to provide treatment coverage.

Georgia is one of only 16 states that don’t require the coverage, according to state Rep. Ben Harbin, R-Evans, who is the lead sponsor of “Ava’s Law” that would compel insurers in the state to pay for the treatments. The bill is named after Anna Bullard’s daughter, who was diagnosed with autism at the age of 2 and who was denied coverage under the state employee health plan in 2006.

“That was almost more of a devastating blow than the diagnosis,” said Bullard, of Lyons. “The diagnosis was something I could see, we could get treatment for, we could help her. But with insurance not covering it, I wasn’t sure what we would do.”

Bullard said she and her husband, who is a schoolteacher, maxed out their credit cards and received financial help from her parents to cover the treatments for Ava, which cost about $5,000 a month. Now 9, Ava is doing well — attending school in a regular classroom and making friends.

“I keep fighting for that very reason, because Ava doesn’t need treatment any more. Every child deserves that chance,” said Bullard, who plans to go to the Capitol twice a week to advocate passage of the bill.

At the core of autism are developmental disabilities that affect the ability to communicate, understand language, play and relate to others.

Details of specific treatments that might be covered, for how long and for what age must still be worked out by the Department of Community Health, which oversees the state employee health plan. Nearly 635,000 members and dependents were enrolled in the state plan as of December.

And lawmakers must still sign off on the governor’s proposal and could make changes under the current budget process. Lawmakers are required to pass a balanced budget before the end of the session.

A decision on how to pay for the coverage change has yet to be made. State officials said it was possible it could be a combination of department funds and a minimal per-member, per-month premium increase.

Bullard and Harbin both said they were grateful to the governor and hoped his proposal would prompt lawmakers to take action on “Ava’s Law.”

Harbin said lawmakers can be uncomfortable with an insurance mandate but hopes they will be convinced of the broader benefits of offering the treatment, which can reduce the costs of services a child with autism might need.

“Everyone can see this works,” Harbin said. “These therapies give children a better quality of life and they save us money in the long run.”

The governor’s budget proposal also included about $853,000 to provide hearing aids for children under the state plan.

Rep. Ed Lindsey, R-Atlanta, the lead sponsor of a bill to require insurers to cover hearing aids for children, said he was excited about the governor’s plan. He said the hearing aids can cost between $1,500 and $3,500 and the lack of coverage hurts middle-class families the most since it’s a covered expense under Medicaid.

“We know they need the care. We need to be doing the next step in assisting these children to have a full and productive life,” Lindsey said.

Times staff writer Joshua Silavent and the Associated Press contributed to this report.


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