There’s a new law. You’ve heard about it through the grapevine, your pediatrician, your regional center, current ABA provider, or friend. Things are changing in California.
So what does it all mean and how did we get here? And more importantly, how can you go about understanding how this affects your child’s services?
So let’s start with the basics:
The state of California now requires insurance companies to provide coverage for the treatment of autism (SB946). Currently 29 states meet this requirement.
The age-old question has remained – is autism a medical concern or an educational concern? Historically, insurance companies have long felt that it is an educational issue and cite “Free and Appropriate Public Education (FAPE) as evidence that autism treatment should be included in school district funding. In contrast, school districts limit autism treatment to behavior problems that interfere with the child “accessing the school-based curriculum.” In other words, if a behavior problem is present but does not directly interfere with the child’s learning, it often goes untargeted even if it may result in social stigma or isolation during recess. Now don’t worry yet, this doesn’t mean that a resourceful teacher or aide won’t target these skills, but rather they are not required to target them.
Then we have the California Regional Center system. We’re going to give you some detailed history about the regional center in an upcoming post. But for now, what you should know is that the Regional Center is the “funder of last resort.” This means that with insurance mandated to provide coverage, if you are receiving services through an insurance company, you may not qualify for regional center services unless they are not covered in your insurance plan. However, some regional centers may aide with insurance co-pay if you meet a certain minimum income level.
So what happens for families that are currently receiving regional center services and are hoping to receive services through their insurance provider? Here are a few suggestions:
- Ask your in-home service provider whether they accept insurance, and ask which insurance companies they work with.
- Ask your in-home provider whether they are already approved to receive insurance clients. Some agencies negotiated their rates and became an insurance provider before the insurance mandate was passed are already in the system. Other agencies that are just now going through the process could potentially cause a hold up in your child receiving services.
- Request information on your co-pay cost. Families may be required to pay a co-pay for each visit. A co-pay can average between $10 to $35 per ABA provider visit.
- Request information from the regional center regarding co-pay aide. Since the regional center is the funder of last resort, they may aide with co-payment during the regional center to insurance transition.
- Be aware that a Regional Center is required to provide at least 30-days-notice before changing any service provision such as decrease of hours or termination of services. That being said, know that time is on your side if you experience any difficulty with your child’s service change.
- Call your insurance caseworker and ask if they accept out of network providers such as the one you are currently assigned to through the regional centers.
Having the answer to these questions prior to beginning the insurance process will help your insurance case coordinator and will help you make an informed decision when deciding whether to switch providers or stay with your current provider.
Have any unanswered questions? Leave them below!
Here are some additional resources that might help navigate this process: