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Insurance Coverage 

Michigan

Michigan's Autism Insurance Reform legislation (PA 99 and PA 100 of 2012) went into effect on October 15, 2012. For-profit, commercial, HMO, and non-profit health insurance companies regulated by the state of Michigan are mandated to provide an autism benefit to its insured members covering services related to the diagnosis and treatment of autism spectrum disorders (ASD) through 18 years of age. Self-funded insurance plans are regulated by Employee Retirement Income Security Act commonly referred to as ERISA through federal law. Self-funded insurance plans are not mandated to provide autism coverage.

IS MY PLAN COVERED ?

To find out if your health insurance plan is covered by this legislation you must first know what kind of plan you have. Many people are unsure what kind of health insurance plan they have. Pathfinders for Autism have put together a helpful set of questions to help you figure this out here (you will need to substitute Michigan for Maryland). Autism Speaks suggests some other resources you may need to determine your plan type in their "before you begin" section here.

For Michigan specific information Autism Speaks has an FAQ page that you might find helpful. Click here to link to that page.

Michigan Medicaid

Coverage of Applied Behavior Analysis (ABA) services  is provided for Medicaid eligible children under 21 years of age who are diagnosed with Autism Spectrum Disorder (ASD) and who meet medical necessity criteria. ABA is a Medicaid covered service under the Behavioral Health Treatment “umbrella” within the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) benefit. Services are provided through the local Community Mental Health programs (CMHs).

To learn how to access ABA services through Michigan Medicaid click here.

Plans covered by Federal Mandates

In addition to plans covered by Michigan law, several plans have ABA benefits due to Federal law.

Federal Employee Insurance

Starting in January 2017 all Federal Employee Health Plans are required to cover ABA.  Click here to learn more.

TRICARE

The TRICARE Comprehensive Autism Care Demonstration (Autism Care Demo) covers applied behavior analysis (ABA) for all TRICARE beneficiaries diagnosed with autism spectrum disorder (ASD). Click here for information about this benefit.

Out of State plans

If the company you work for is headquartered in another state and that state has an Autism Mandate, depending on whether that mandate applies to the type of insurance your company provides, you may have coverage for ABA. Click here for a list of states that have passed Autism Insurance mandates and an overview of what is covered. There is quite a high chance in this instance though that your plan is a self-funded plan

YES, MY PLAN IS COVERED

If you have determined that your plan is covered, armed with a copy of the law (see link at the top of the page) call your insurance company to verify that you have ABA benefits. If you are still being denied coverage here is where to go to file an appeal. Also, here is a link to a great resource from Autism Speaks to work with your  self-funded insurance company to add the ABA benefit

 FIRST STEPS

#1 Determine which kind of health care plan you have

#2 Verify with your plan that you have ABA benefits

#3 Request pre-authorization for ABA services

Self Insured Companies

An increasing numbers of self-insured companies are chosing to cover ABA.According to a list publised in the APBA newsletter in February 2009, the following self-insured companies provide coverage in their health insurance for ABA services in Maryland.

  • Eli Lilly 
  • Home Depot 
  • IBM (limited coverage)
  • Johns Hopkins Healthcare
  • Microsoft 
  • Symantec 

In Michigan, according to a list published by Autism Speaks in 2014, the following Michigan-based, self-insured companies provide coverage.

  • Chrysler
  • DTE Energy
  • E.Michigan University
  • General Motors
  • University of Michigan

A more complete list of companies providing Autism benefits through their self-funded plans is available here from Autism Speaks.

We cannot guarentee that these lists are accurate or that all employee poilcies include coverage. Remember, Autism Speaks provides an excellent tool for you to use to advocate for your companies self-funded plan to add an Autism benefit.

Other funding options for families in Michigan

Grants

We have listed the grants that we know about. There may be many more that we do not know about.These grants tend to run out very quickly and be difficult to get but are well worth pursuing anyway!

United Healthcare Children's Foundation Grants

National Autism Association Helping Hand Grant

ACT Today Grant Program

Flexible Spending Accounts

If you have a letter of medical necessity from your doctor many families have found that flexible spending accounts will cover ABA services. .