Autism Insurance FAQs

Q: Is autism a big deal in Utah?
A: Yes!  According to a recent study from the Center of Disease Control, Utah leads the nation with the highest autism rates.  1 in 47 children in Utah is affected by autism. The national prevalence rate for autism is 1 in 88 . Whether that is because of the Utah autism community’s intense efforts to diagnose and treat children with autism, more advanced medical record-keeping, environmental , genetic, or other reasons is unknown.

Q: Why isn’t autism covered by health insurance plans?
A: In Utah, insurance carriers are not required to cover autism under medical or mental health benefit plans.  This allows insurance companies to deny diagnosis, treatment, and on occasion basic medical coverage, for those with autism spectrum disorders.

Q: Can autism be successfully treated?
A: Yes - Autism is treatable!  Studies have shown that individuals with autism who receive intensive evidence-based intervention and therapy have 80-90% success rates at enabling people to manage the symptoms of autism.  Studies also show that 47% of individuals with autism who received these therapies attained normal intellectual functioning whereas only 2% of individuals with autism who did not receive these therapies attained normal intellectual functioning.  Basically, therapy can make the difference between a nonverbal adult living on state assistance, to a verbal functioning adult who has a job and pays taxes.

Q: Does it matter when kids receive autism treatments?
A: Yes!  Although individuals with autism can and do make improvements their entire life, the earlier intense intervention and treatment are provided the better.  This is why it is so important Utah pass autism insurance reform now. The sooner intense autism therapy is provided the better the outcomes. As prevalence rates increase, every year that we wait will result in loss of functional capacity for individuals with autism and increased costs to society.

Q: How many states have passed autism insurance reform?
A: As of August 2013, 34 states have passed autism insurance reform.  These states include: Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware,  Florida, Iowa, Illinois, Indiana, Kansas, Kentucky, Louisiana, Maine, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, Oregon, Pennsylvania, Rhode Island, South Carolina, Texas, Vermont, Virginia, West Virginia, and Wisconsin.

Q: Is autism insurance reform a partisan issue?
A: Absolutely not!  Autism affects everyone, no matter what the party.  Autism insurance reform has been passed in some of the most conservative states in the nation including: Texas, Arizona, Louisiana, South Carolina, and Arkansas to name a few.

Q: How much will my insurance go up if an autism insurance mandate is passed?
A: We can't tell you what the insurance companies will do, but we can tell you how much the actual cost has been in other states. If you take the dollar amount of autism-related claims and divide by the number of people covered, you get the "per member per month" (PMPM) cost. According to data from states with autism insurance coverage the average PMPM cost was 15 cents the first year after implementation and 31 cents the second year, with greater usage due to increased awareness. That's a minuscule amount, especially when the benefits of autism insurance coverage are so great.

A Missouri Department of Insurance report about their autism coverage says, "Given that treatment for autism represents less than 0.2% of overall claims costs, it is very unlikely that such costs will have an appreciable impact on insurance premiums."

Q: Will small business be forced to drop their insurance plans if an autism insurance mandate is passed?
A: Absolutely not!  This is a scare tactic used by insurance lobbyists.  There is no data from any of the states that have passed autism insurance legislation to support this claim.  

Q: Will autism insurance coverage help Utah’s economy?
A: Yes – in multiple ways.  Autism insurance coverage will bring new meaningful jobs to Utah, save the state and taxpayers millions of dollars every year, and help those with autism become an asset to our community instead of a financial burden.

Q: Why should autism treatment fall under medical benefits instead of under education?
A: Autism is a medical condition diagnosed by medical professionals. Evidence based autism therapies like: Occupational Therapy, Speech Therapy, and Applied Behavior Analysis (ABA) Therapy, are all medical treatments based upon medical models. Teachers and schools are not equipped with the necessarily time, training, or resources to provide medical treatment for children with autism or any other medical condition.  Educational programs are designed to accommodate medical disabilities, but not to treat underlying medical conditions. The treatment of underlying medical conditions is the responsibility of qualified medical providers and not educators. Further, the research available does not indicate that educational programs have demonstrated effectiveness in treating the underlying medical condition of autism.

Currently the burden of treating kids with autism is being placed on schools. Teachers, schools, and school districts all across Utah can tell you they are getting into a crisis situation trying to provide for kids with autism. Our already strapped education system cannot provide the medical treatment autism kids need. Schools are not required to treat any other underlying medical condition; why would they be required to treat autism?

Q: What would be covered under autism insurance?
A: Until we have a bill in front of us it is impossible to say exactly what will be covered.  But, following the basic model of what has successfully passed in other states, evidenced based therapies such as: Applied Behavior Analysis (ABA) therapy, pharmaceuticals, psychiatric treatment, psychological treatment, occupational therapy, speech therapy, and medical treatments, would be covered for individuals with Autism Spectrum Disorder diagnoses who have health insurance policies regulated by the State of Utah.

Q: I’ve heard autism insurance reform will only affect 1/3 of health insurance plans, is that true?
A: This is true. The state of Utah regulates about 1/3rd of health insurance plans held in our state, those plans include: small to medium group plans, and individual plans. The other 2/3rd are regulated by the federal government, those plans include: Medicaid, Medicare, military plans, and large group plans.  

If you have unanswered questions about autism insurance, please email them to us at