Mom tries to close autism coverage loophole

KRQE TV

Tina Jensen

Updated: Jan 25, 2013 11:54 AM

SANTA FE (KRQE) — Research shows autism treatment not only works – it’s crucial to get started early.

But thousands of state workers don't have any insurance coverage for autism , and that forces families who have kids with autism to make tough decisions.

A loophole in state law means certain health insurance plans for public employees don’t have to cover autism, but a bill introduced at the capitol Thursday is trying to change that. 

Shawn Childers, a librarian at East Mountain High, has 6-year-old twins. One has autism, the other does not.

Most weekdays, she takes her son to therapy.

“We currently have occupational therapy through swim, we have ABA - applied behavioral analysis, we have done behavioral therapy and we really push speech therapy,” she said.

Because Childers is a public employee, her family pays thousands of dollars for her son’s treatments each year.

Childers also spends countless hours on the phone with providers and her insurance company to work to get similar diagnoses for her son – like developmental speech delay – so that a fraction of the therapies are covered.

“There are hundreds of families affected and each one has a different story. There are families that don't do therapies because they have no coverage whatsoever. There are families that take out second mortgages and there are families that declare bankruptcy.”

There are also numerous anecdotes of public employees who have considered quitting their jobs to qualify for Medicaid - because Medicaid covers autism and their insurance plans did not.

Childers took the issue to Rep. Jim Smith.

“That's how it came about, it was just a short, brief conversation and I said, that sounds like something we can fix,” said Smith, R-Sandia Park. “I really don't know why this loophole hasn't been closed before.”

So far, the bill has bipartisan support. The bill wouldn’t cost taxpayers, but it would raises insurance premiums slightly for public employees.

“Once people understand this situation exists I think people will do that right thing and make it right for families who have autistic children,” said Sen. Bill O’Neill, D-Albuquerque, the co-sponsor of the legislation.

“Hopefully, this bill will gain momentum. I look forward to it coming over to the Senate where I can present it and send it up to the Governor for her to sign,” he said. 

APS is the only district that has coverage because they use a different insurance exchange. 

The bill passed unanimously in a house committee on Thursday.

If the bill ultimately gets signed into law, hundreds of state workers whose children have autism would start to receive insurance coverage on July 1.
 

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