Bill seeks autism coverage

A Dickinson man, along with the support of a two state senators, is vying to change the future for those with autism-spectrum disorders.

In a state where health insurance companies have very limited coverage of autism-related services, Nick Gates, along with the bill's sponsors Sen. Rich Wardner, R-Dickinson, and Sen. Carolyn Nelson, D-Fargo, will introduce an autism insurance reform bill dubbed "Noah's Law" to the Employee Benefits Programs Committee in the Harvest Room at the state Capitol on April 27 at 9 a.m. CDT.

The bill would require insurance companies to cover autism-spectrum disorders.

North Dakota is one of five states not presently pursuing autism insurance reform, has not enacted any type of reform nor has any endorsed bills, according to www.autismvotes.org .

"We don't get autism-specific services," Gates said. "We get generalized services of occupational, physical and speech therapies."

Gates said applied behavioral analysis therapies and early intervention behavioral therapies are most needed but not covered.

Early intervention is key and is ideally done between the ages of 3 and 7, Gates said.

"As soon as you can diagnose, you need to get them into that intensive behavioral intervention and start with that," Gates said. "We can't have that delay."

Gates said it took six months to obtain an official diagnosis for his son, Noah.

"That was six months that we could have been working really hard with him," Gates said.

For about six to seven months after Noah's diagnosis, Gates and his wife paid for early intervention services out of pocket, as they didn't qualify for any area assistance nor did their insurance cover all that was needed.

Gates estimates in that time frame, he and his wife spent about $6,000 in out-of-pocket costs.

Some with insurance plans that provide early intervention coverage also feel something needs to change.

Sandy Smith of West Fargo, whose 8-year-old son attends the North Dakota Autism Center, Inc. in Fargo, said she receives autism coverage though her job, but only because the insurance company is based out of Washington state.

Smith said no insurance companies in the state provide such coverage and Blue Cross Blue Shield of North Dakota cites autism as an education issue.

Smith said that if she used the entire amount covered by her insurance company immediately when her son was diagnosed at 18 months old, it would have covered about 40 hours of early behavioral intervention a week for three years.

Smith cites the question whether to cover autism-spectrum disorders coverage as a "pay me now or pay me later type of thing."

"These kids are just going to require more services throughout their lifetime," she said. "Why not do it early so the child can actually have a better prognosis?"

It is estimated the lifetime cost of caring for a child with autism falls between $3.5 million to $5 million, according to the Autism Society's Web site.

Smith said if early intervention is done, that amount could be significantly reduced.

Smith said due to the lack of depth in health insurance coverage for autism-related services, many specialists won't offer their services in North Dakota, meaning there are fewer options for early intervention.

"We will never be able to attract autism professionals, skilled trained certified autism professionals in our state unless they can get paid," Smith said. "No one's coming and they won't until either insurance or Medicaid starts paying for it."

Smith said if she couldn't have found services for her son, she would have moved to another location that did offer the services.

Some not directly affected by autism can understand the need.

Wardner said he and his wife Kayleen were once educators and from that experience, they are aware of the specialized needs of autistic children.

"I understand some of the challenges that go along with raising a child that is autistic," Wardner said. "It is a situation where you have a unique case where there are a lot of medical expenses."

Wardner said after the bill is introduced, the committee will decide whether or not to recommend the bill for further proceedings.

Presentation of the bill could not have come at a more appropriate time: April is autism awareness month.