Raising a child with special needs can be physically, emotionally, and financially draining. Insurance coverage may barely make a dent in the costs for specialized medical care, childcare, recreational needs, and other care a child with autism or other special needs may require in their lifetime.
As coverage expands for children with autism throughout the United States and autism mandates are being passed; it benefits some, but not all families. There are still many loopholes in coverage and self-funded plans have discretion whether they will cover members for treatment related to autism. For those that do have coverage, many have a significant out of pocket costs for deductibles, co-insurance and out of pocket maximums that may range between $5,000-$10,000 annually. Many services that are beneficial to children with autism are not considered medical and are not covered by health insurance, which leaves parents/guardians with more expense.
As parents seek coverage for ABA therapy or other medical services for their children, many have turned to the marketplace for commercial health plans which offer coverage for autism; however, these plans may be very costly and unavailable to some. Other parents have turned to state Medicaid programs or other government or waiver programs for coverage, which can vary significantly from state to state. It is beneficial for parents/guardians to seek out all coverage options for their child as costs continue to mount.
Tips for providers to help families with financial burdens:
- Become a Medicaid provider in your area and encourage your patients to apply for Medicaid.
- Detailed explanations of financial obligations- knowing up front makes it easier for families to plan accordingly.
- Encourage use of Health Savings Accounts or Flexible Spending Accounts, if possible.
- Payment plans for patient responsibility.
- Develop a financial hardship policy.
- Keep abreast of community resources and refer as much as possible.
Grants may be available for children for their treatment, specialized equipment, or other needs.
Refer to these organizations for lists of available grants:
Autism Support Network
American Autism Association
The Autism Community in Action (TACA)
Autism Parenting Magazine
Outreach Autism Services Network
If you find billing and funding overwhelming,
Missing Piece Billing and Consulting can help.
Please contact us to schedule your free evaluation at
firstname.lastname@example.org or 765-628-7400.