Group Health Cooperative has settled a class-action lawsuit by agreeing to cover behavioral-health treatment for autism, an important moment and model for other Washington insurers.
Indeed, the state Health Care Authority followed with its partial settlement of a class-action lawsuit, agreeing to cover intensive early-intervention behavior therapy for children with autism-spectrum disorders whose parents have health insurance through the state’s Uniform Medical Plan. Coverage for Medicaid patients is also close to an agreement.
Convincing insurers to pay for neurodevelopmental and behavioral therapies used to treat this range of clinical conditions is a huge step that ought not be downplayed. These therapies can produce dramatic improvements in children with autism, allowing them to attend school and participate in mainstream activities.
Therapeutic costs can easily run families tens of thousands of dollars a year.
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Washington’s mental-health parity law requires coverage for neurodevelopmental and behavioral therapies. That’s considerable leverage, but it did not stop insurers from excluding the therapies. Adding to families’ challenge in getting coverage is the debate over whether certain treatments are medical, and covered by insurance, or educational, and thus falling under the responsibility of public schools.
Efforts over the years by autism-advocacy groups to get the state Legislature to mandate coverage were consistently opposed by insurers. So advocates headed to the courts.
With Group Health and the Health Care Authority’s agreements, settlements in other lawsuits, including against Premera Blue Cross and Regence Blue Shield, should be next.
Agreements about coverage must happen. That’s exactly what the state’s Mental Health Parity Act promised. Autism is among the fastest-growing developmental disabilities in the nation. The Centers for Disease Control and Prevention estimates 1 in 88 children has some form of autism-spectrum disorder.
The rise in diagnoses and treatments has spurred lawsuits across the country as families battle states, insurers and public schools for coverage.
Early investment in these therapies make a big difference for a lifetime.