Recognizing the importance of early intervention for Autism Spectrum Disorders (ASD), 29 states have
enacted autism insurance reform laws. Each of these states require that health insurance cover
medically necessary treatment for ASD including behavioral health treatments such as Applied
Behavior Analysis (ABA).
In order to determine the fiscal impact of autism insurance reform, Autism Speaks is collecting claims
data from states where such laws apply to members of the state employee health plan and have been
in effect for at least one year.
Interpretive Summary
1. Autism insurance reform laws have been in effect for at least one year in 15 states. Twelve of these
states require coverage for members of their state employee health plan. The terms of coverage
vary and are detailed in Appendix 1.
2. Claims data has been requested from all 12 states. Data has been received from 6 states and is
presented in Appendix 2.
3. Claims data is available from the first year of implementation in 5 states (i.e., SC, IL, FL, AZ and KY).
The first year costs of coverage range from $0.09 per member per month (PMPM) to $0.30 PMPM.
The average first year cost of coverage is $0.15 PMPM. (Table 1)
4. Claims data is available from the second year of implementation in 5 states (i.e., SC, IL, LA, FL and
AZ). The second year costs of coverage range from $0.10 PMPM to $0.43 PMPM. The average
second year cost of coverage is $0.31 PMPM. (Table 2)
5. Minnesota has not enacted autism insurance reform. However as a result of a settlement of litigation
against Blue Cross and Blue Shield of Minnesota, they have been required to cover unlimited
treatment for ASD since 2001. After 6 years, the premium impact on the commercial market
resulting from unlimited coverage for ASD was $0.83 PMPM. (BCBS Minnesota)
6. Fiscal notes were prepared for the legislatures in 5 of the states where we have been able to obtain
claims data. These cost projections were prepared for fiscal or calendar years that correspond to
available claims data in 3 states. Fiscal projections overestimated the actual cost of autism
insurance reform by 293% to 1,261%. (Table 3)
