Insurance Companies Required To Cover Autism Services In PA

PENNSYLVANIA — Insurance coverage will be guaranteed for the approximately 55,000 Pennsylvanians with autism, under a new state directive announced this week.

Commercial insurance companies will be required to handle claims for autism services in compliance with state mental health equality laws, Gov. Josh Shapiro announced on Wednesday along with leaders from Drexel University and the Eagles Autism Foundation. The Pennsylvania Insurance Department advised all insurers offering commercial health insurance policies that they must adjust their policies to cover autism care by Jan. 1, 2024.

Some commercial insurers have historically categorized autism services as a physical health benefit, officials said. And while most major health insurers in the state already treat autism as a mental health condition, the Pennsylvania Insurance Department will require the remaining providers to do the same.

“Our federal government has frankly failed to establish nationwide standards, resulting in families here in Pennsylvania oftentimes being shut out of coverage or being unable to afford vital services that their loved ones need,” Shapiro said.

Autism advocate Michael Alos said that getting insurance to cover assessments, therapies, and other services can be expensive, if they are even available. Alos, who was diagnosed with autism as an adult, said that wider accessibility to services for autistic children and adults could help more families in Pennsylvania get the support they need.

“The earlier that autism is detected and the more treatments that are available, the better the autistic person can benefit from therapies, support and ongoing school accommodations,” Alos said.

“While I’m happy with who I am and the life I have today, I experienced unnecessary struggles and hardships that I might not have experienced if I had been diagnosed in childhood, and if the treatment options were different in Pennsylvania,” he continued.

Ryan Hammond, executive director of the Eagles Autism Foundation, also spoke to the importance of providing access to services.

“We know intervention and support is critical in changing the trajectory and outcomes in a person’s life and we believe through this policy, families’ needs will be better served, and lives will be changed as a result,” Hammond said.