Blog

Support the continuation of the Affordable Care Act – heavily involved in affordable access to ABA in Oregon

Access to insurance-funded ABA in Oregon involves a combination of five state and federal laws/statues. Changes to the Affordable Care Act could have a huge impact on our clients’ ability to acquire/access coverage for those services. A big post on this topic coming in the next day or so with information on how to contact your senators and support upholding the full ACA.

In the meantime, please read Autism insurance expert Paul Terdal’s website: Autism Insurance of Oregon and subscribe to his email list. He recently posted on some big changes to OHP and on the potential effects of an ACA repeal. Here is a quote from his summary:

“Autism Health Insurance Reform in Oregon relies on a complex combination of state and federal laws, including:

  • ORS 743A.168 – Oregon’s Mental Health Parity law from 2005
  • ORS 743A.190 – Oregon’s first autism mandate from 2007
  • SB365 (2013) and SB696 (2015) – Oregon’s revised autism mandates which specifically describe minimum requirements for coverage of Applied Behavior Analysis (ABA)
  • Federal Mental Health Parity and Addiction Equity Act (MHPAEA)
  • The Affordable Care Act

These laws overlap and enhance each other; for instance, SB365 required coverage of treatment for autism, but allowed for some age and visit limits on care; ORS 743A.168 and MHPAEA overrode those limits to provide coverage for all ages, limited only by medical necessity. The ACA extended that enhanced coverage to individual plans that anyone could purchase through the health exchange, even if they had a pre-existing condition (such as autism).

Even with a full repeal of the Affordable Care Act, health insurance policies in Oregon will still need to provide coverage of treatment for autism, with significant gaps and issues:

  • Individual plans would no longer be required to comply with state or federal Mental Health Parity, and could start imposing age and visit limits on coverage.
  • Consumers could lose the ability to purchase individual insurance plans from the Health Exchange. In many cases, large plans from large out of state employers continue to deny coverage of ABA or other autism treatments – consumers have worked around this by buying low-cost individual plans for their children, which have the comprehensive autism coverage that Oregon requires.
  • Insurance companies could start denying coverage for individuals with pre-existing conditions. Everyone with an autism diagnosis has a “pre-existing condition” – which could make it difficult or impossible to buy health insurance at all.
  • The Mental Health Parity requirements for Medicaid would be repealed, enabling OHP to resume or continue some of the types of denials that we have been fighting against, such as age and visit limits on treatment for autism and other mental health conditions.
  • Medicaid expansion funding would be lost, reducing the number of people who could be covered on OHP and funding for the K-Plan.
  • Subsidies for commercial insurance through the exchange would be lost, so consumers who purchase insurance would be required to pay the full price regardless of income.
  • As noted above, under some proposals, Medicaid could be converted to a block grant program which would reduce existing funding levels and eliminate any requirements for coverage, including the EPSDT and Mental Health Parity requirements. See Disability Rights Oregon’s blog entry on this.”

If you have ideas for action, please contact ORABA!

Comments