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Sunday, January 25, 2015

Autism Insurance, ARICA and the Health Connector Open Enrollment Information

Advocates for Autism of Massachusetts

 January 21, 2015
General Information

ARICA is a law in Massachusetts which requires health insurers in Massachusetts to provide coverage for the diagnosis and treatment of Autism Spectrum Disorder, including, but not limited to, Applied Behavior Analysis (ABA) therapy.

However this law only affects certain types of health care policies (private insurers, employees and retirees under the state plan, hospital service plans and HMOs), so coverage under ARICA depends on the type of policy you have. Self-funded plans and MassHealth are not subject to ARICA:
  • Self- Funded Plans - Many of the State's largest employers provide coverage through self-funded plans. These plans are federally regulated, and not subject to State laws. If your plan is self-funded, your company may provide coverage under ARICA, and/or cover autism therapies, but it is not required. For people with autism who need ABA and other behavioral therapies, self-funded plans may not cover them.
  • MassHealth is also not subject to ARICA. MassHealth covers many treatments and services for people with autism, but does not cover ABA therapy, except under MassHealth's Home and Community Based Services Autism waiver, and under MassHealth's 1115 Demonstration Project for children receiving early intervention from the Department of Public Health. This is expected to change sometime in 2015, but the details and timeframe for implementation are still being worked out.

The Health Connector currently has an Open Enrollment period, until February 15, 2015. During this Open Enrollment, people in Massachusetts have the opportunity to purchase private insurance policies through the Connector. These policies are subject to ARICA, and provide access to medically-necessary autism treatments, including ABA therapy that might not be covered by self-funded plans or MassHealth.

If your current insurance doesn't cover the autism therapies you need, you might want to consider purchasing an unsubsidized qualified health plan during this Open Enrollment. For many people, MassHealth Premium Assistance (PA) is available to cover the cost of purchasing these policies.

For additional information, including enrollment instructions, click here.

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