There are a lot of rumors out on how Obamacare would affect Emma's access to therapy.
Emma has therapy through Magellan. She also has it through our primary insurer - United Behavioral Health. Our insurance has a family out of pocket of $12,000 before it kicks in. This means that all of the diabetes medications I use and the doctors I see are sefl-pay until we reach our family limit.
As far as I understand, the plan by Obamacare says that insurance has to pay for therapy... however, many families still will not be able to afford the type of insurance that will make it possible.
You are welcome to read below.
Lisa
How the Affordable Care Act Affects People with Autism
The ACA plan contains important provisions for individuals with autism and related conditions and their families. Starting in 2014, individuals on the autism spectrum and families of children on the autism spectrum will have expanded access to affordable insurance options through new Affordable Insurance Exchanges and improvements in Medicaid.
At the same time, new health plans sold in the individual and small group markets, including Exchanges, will cover “essential health benefits” to help make sure that health insurance is comprehensive. Health insurers will also have annual out-of-pocket limits to protect families’ incomes against the high cost of health care services. Congress specified in ACA documentation that one of the EHB categories must be “mental health and substance use disorder services, including behavioral health treatment.” This was added to ensure coverage for individuals on the autism spectrum and for those with other developmental disabilities.
Unfortunately, in its latest guidance to the states, issued just prior to Thanksgiving 2012, the U.S. Department of Health and Human Services issued a proposed rule that could exclude access to behavioral health treatment in up to 21 states. But under the new HHS proposal, coverage of behavioral health treatment would be determined by whether a state had its own autism insurance reform law on the books by Dec. 31, 2011. Specifically, any state-mandated benefits, such as autism insurance reform laws, added after Dec. 31, 2011, cannot be part of the EHB for 2014 and 2015, under the new HHS proposal. Many advocacy groups will continue to put pressure on the Obama Administration and individual states legislatures to carry out the intent of Congress in adding “behavioral health treatment” as required care for people with autism spectrum disorders.
A total of 37 states and the District of Columbia have laws related to autism and insurance coverage. At least 31 states specifically require insurers to provide coverage for the treatment of autism. Alabama requires insurers to offer autism coverage in certain situations. Vermont amended its law to cover treatment for early childhood developmental disorders, which includes autism spectrum disorders. Other states may require limited coverage for autism under mental health coverage or other laws. Both Connecticut and New York have signed into law respective health insurance mandates prior to Dec. 31, 2011, therefore making these states eligible for “behavioral health treatment” including Applied Behavioral Analysis for autism spectrum disorders under the ACA.
Thanks for the birthday wishes! It's always so nice when my birthday falls on Easter and I get to spend the day with so much family. I really enjoyed my bday cheesecake, amaretto sours, and the large selection of meats. Andy surprised me with a certificate for car detailing, which I was recently thinking I really needed so that was great, too.
Hey, Straubettes, we will be having a baby shower for Brianne, Joe and new Baby on Sunday, May 12 in Des Moines. That's Mother's Day. You are welcome to stay with us, or make it a fun family weekend at the farm and drive up here Sunday morning! It's only an hour drive. There is also a short bike ride/ art ride going on starting not too far from our house that afternoon if anyone is interested,
11 comments:
Happy day to all of you! Enjoy your birthdays/anniversary.
Monca
Happy Easter everyone. Love, Mom and Dad
Happy birthday Don! Happy birthday Ellen! Happy anniversary Mary and Mike!
It was a great weekend at Monica's house. Thanks to her and Joe for hosting us all!
P
Happy Birthday to Ellen and Don. Happy Anniversary to Mary and Mike! Great weekend at Monica and Joe's.
So who has watched the Ware leg injury about fifteen times?
Happy birthday to Ellen and Donnie!
Saw Ellen and crew yesterday. She had cheesecake and Easter dinner at Cathy & Steve's for her birthday.
I am still full.
Happy anniversary to Mary & Mike!
lisa
Happy Birthday, Don!
Happy Birthday, Ellen!
Happy Anniversary, Mary and Mike!
Watched the Ware thing twice on Ryan's phone. Aaaugh.
Cathy
There are a lot of rumors out on how Obamacare would affect Emma's access to therapy.
Emma has therapy through Magellan. She also has it through our primary insurer - United Behavioral Health. Our insurance has a family out of pocket of $12,000 before it kicks in. This means that all of the diabetes medications I use and the doctors I see are sefl-pay until we reach our family limit.
As far as I understand, the plan by Obamacare says that insurance has to pay for therapy... however, many families still will not be able to afford the type of insurance that will make it possible.
You are welcome to read below.
Lisa
How the Affordable Care Act Affects People with Autism
The ACA plan contains important provisions for individuals with autism and related conditions and their families. Starting in 2014, individuals on the autism spectrum and families of children on the autism spectrum will have expanded access to affordable insurance options through new Affordable Insurance Exchanges and improvements in Medicaid.
At the same time, new health plans sold in the individual and small group markets, including Exchanges, will cover “essential health benefits” to help make sure that health insurance is comprehensive. Health insurers will also have annual out-of-pocket limits to protect families’ incomes against the high cost of health care services. Congress specified in ACA documentation that one of the EHB categories must be “mental health and substance use disorder services, including behavioral health treatment.” This was added to ensure coverage for individuals on the autism spectrum and for those with other developmental disabilities.
Unfortunately, in its latest guidance to the states, issued just prior to Thanksgiving 2012, the U.S. Department of Health and Human Services issued a proposed rule that could exclude access to behavioral health treatment in up to 21 states. But under the new HHS proposal, coverage of behavioral health treatment would be determined by whether a state had its own autism insurance reform law on the books by Dec. 31, 2011. Specifically, any state-mandated benefits, such as autism insurance reform laws, added after Dec. 31, 2011, cannot be part of the EHB for 2014 and 2015, under the new HHS proposal. Many advocacy groups will continue to put pressure on the Obama Administration and individual states legislatures to carry out the intent of Congress in adding “behavioral health treatment” as required care for people with autism spectrum disorders.
A total of 37 states and the District of Columbia have laws related to autism and insurance coverage. At least 31 states specifically require insurers to provide coverage for the treatment of autism. Alabama requires insurers to offer autism coverage in certain situations. Vermont amended its law to cover treatment for early childhood developmental disorders, which includes autism spectrum disorders. Other states may require limited coverage for autism under mental health coverage or other laws. Both Connecticut and New York have signed into law respective health insurance mandates prior to Dec. 31, 2011, therefore making these states eligible for “behavioral health treatment” including Applied Behavioral Analysis for autism spectrum disorders under the ACA.
Thanks for the birthday wishes! It's always so nice when my birthday falls on Easter and I get to spend the day with so much family. I really enjoyed my bday cheesecake, amaretto sours, and the large selection of meats. Andy surprised me with a certificate for car detailing, which I was recently thinking I really needed so that was great, too.
Hey, Straubettes, we will be having a baby shower for Brianne, Joe and new Baby on Sunday, May 12 in Des Moines. That's Mother's Day. You are welcome to stay with us, or make it a fun family weekend at the farm and drive up here Sunday morning! It's only an hour drive. There is also a short bike ride/ art ride going on starting not too far from our house that afternoon if anyone is interested,
Lisa, You mentioned a $12,000 deductible. Is that annual, so that you have to pay $12,000 each year until the insurance kicks in?
Dad
Scary possibilities, Lisa. It seems state specific. What are Iowa's current laws?
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