Why some states have more generous insurance mandates for autism

One in 59 children have been diagnosed with Autism Spectrum Disorder (ASD), according to the Centers for Disease Control and Prevention (CDC). Needed treatments for ASD can be costly, and historically insurance companies have refused to pay for care for those with ASD even though federal laws require states to meet certain thresholds regarding insurance coverage. Through the efforts of ASD advocates over the past two decades, some states have enacted mandates that insurers include coverage for those with ASD.

In a study published in PLOS ONE, Timothy Callaghan, PhD, assistant professor in the Health Policy and Management Department of the Texas A&M School of Public Health, and Stephen Sylvester, PhD, analyzed why some states passed more generous insurance mandates than others, opening eligibility for benefits to more or fewer children with ASD. The study analyzed every ASD insurance mandate passed in the U.S. from 2000 to 2017.

In the study, Callaghan ran statistical models looking at a variety of factors that could possibly influence state insurance mandates, including partisanship, interest group activity and the state insurance environment.

“When controlling for a variety of different factors, we found that citizen ideology and the ideology of state politicians determine how generous states tend to be regarding insurance mandates,” Callaghan said. “States that tend to be run by more liberal legislatures and states with more liberal citizenries are more likely to enact generous insurance mandates, which allow more children to access more health benefits if they have autism.”

Although there is consensus that Applied Behavior Analysis and other clinical therapies are helpful in producing better outcomes for children with autism, many insurers continue to argue that behavioral treatments are not medically necessary, according to Callaghan.

Because policy drastically affects the amount of access people have to health care, Callaghan stressed the importance of studying these mandates to further analyze their effectiveness.

“Insurance mandates that ensure coverage are an important but understudied area of research, especially when trying to understand why some states are more generous in the mandates they design,” Callaghan said. “Having a mandate isn’t enough. This mandate can be very generous and include lots of people or can be very restrictive, making it not very useful. Scholars need to pay more attention to making sure that they are looking at the generosity of a particular insurance mandate, and not just the existence of it.”