Washington State Legislature has provided funding to help families navigate health insurance coverage
Washington State Legislature has provided funding to Washington Autism Alliance & Advocacy (WAAA) to help autistic individuals or families with autistic children navigate health insurance coverage as Washington State transitions to federal health reform.
While many in Washington Sate are working to improve access to screening for autism (mostly at public expense), majority of providers assume treatment is coming from public schools. Even in cases when medically necessary autism services are prescribed, there continues to be significant obstacles to insurance coverage of screening, diagnosis and early intervention and medically necessary treatment. Health insurance laws are complex. We at Washington Autism Alliance & Advocacy (WAAA) have extensive experience in communicating these complex programs in terms suited to target populations. We will continue to helping level the playing field for consumers relying on insurance benefits for services related to autism.
There is currently a far greater demand in our State for legal advice and representation to individuals denied coverage of treatment for autism spectrum disorders (ASD’s) than the bar has the capacity to provide, particularly in areas outside Seattle. The expansion of coverage achieved through health care reform combined with recent legal decisions establishing the right to coverage of ASD therapies will only expand this already pressing need. WAAA staff can provide important advice to clients seeking assistance with coverage appeals. But, WAAA’s limited resources make it critical for us to develop the outside legal capacity available to low and moderate income individuals in community to provide this representation so that no one will be denied the coverage to which they are entitled because of a lack of legal staff with the expertise and support to take these cases.
WAAA shall provide written materials, web-based video content, webinars and other trainings to educate individuals on how to access ASD treatment coverage for themselves and their families, and to educate the primary organizations already furnishing advice and assistance to individuals with complaints about their health insurance coverage or seeking information about disability-related services.
Many changes to our health coverage system resulting from the implementation of the Affordable Care Act will strongly impact the ability of families to access coverage for ASD treatments, including the manner in which Essential Health Benefits are defined, changes to the legal requirements for how private insurance plans’ grievance systems operate, expansions of eligibility for Medicaid, parity in service coverage between different Medicaid eligibility categories, and method for determining MAGI-eligibility for premium and cost-sharing assistance for Exchange-purchased coverage. To best serve individuals with ASD’s and their families, WAAA has joined the coalitions of labor, provider, and consumer-based organizations that have already played a major role in successfully advocating for consumer-friendly actions in implementing the ACA in Washington State and across the nation.
By working with professionals who are leaders in screening, diagnosis and treatment of autism, regional service hubs, and statewide autism service organizations we will continue to bolster our Professional & Resource Directory to improve provider referrals. We will also ensure providers know where to access information to ensure their claims are processed accurately and promptly.
Our Advocacy and Resource Coordinators are standing by to help you navigate evidence based screening, diagnosis and treatment of autism.