New York Autism Spectrum Disorder Healthcare Coverage Law

Introduction

The legislation signed by Governor Andrew M. Cuomo of New York on November 1, 2011, requiring health insurance coverage for the treatment of autism spectrum disorder (ASD) represents a significant step forward in health policy. One might argue that such legislation should have come earlier, given that autism is a condition requiring sustained medication and care for affected children. Nevertheless, the law is a laudable development that will benefit families with autistic children by making expensive health care costs more affordable. The law makes it mandatory for health insurance companies to provide coverage for the treatment of autism spectrum disorders, though companies may still resort to "deductibles, co-pays, and coinsurance consistent with those imposed on other benefits" (Cuomo, 2011).

Discussing the law, Governor Andrew M. Cuomo stated that the bill would provide for the diagnosis and treatment of autism by removing financial constraints. He thanked "Senator Fuschillo and Assemblyman Morelle for sponsoring this much-needed legislation" (Cuomo, 2011). Although state law had previously required insurance coverage to include the diagnosis of autism disorder, this new law extends coverage to treatment as well, thereby ending a significant hardship for New York families dealing with autistic members. The bill made New York the 29th state to provide health insurance coverage for autism spectrum disorder, and it takes effect from November 1, 2012, for all policies renewed or issued on or after that date (Cuomo, 2011).

Key Provisions of the New York ASD Law

The bill was the result of drafting work by Dean G. Skelos, Senator Fuschillo, and Senator McDonald. It was viewed as a vital tool for detecting and addressing autism spectrum disorders by Dr. Nirav Shah, Commissioner of the Department of Health. The bill was also welcomed by notable figures including John B. King, Jr., State Education Commissioner, and Paul A. Hamlin, MD, President of the Medical Society of the State of New York (Cuomo, 2011).

Autism spectrum disorders are found in approximately one in every 110 children, and in New York alone, approximately 30,000 children have been identified with an ASD. There are challenges beyond financial ones, given that health care policies have historically been in a state of flux. The core problem is that an autistic individual is unlikely to lead a fully independent life without significant support, and since there is no complete cure for autism, other people — particularly family members — must help them throughout their lives.

Financial Impact on Families with Autistic Children

This reality places a significant drain on caregivers, especially the immediate family of the autistic individual. The important fiscal challenge lies in apportioning family income across various needs while simultaneously supporting the autistic person. Where the individual is dependent on an ever-increasing demand for services, pressure mounts on the family's financial reserves, potentially pushing the family into poverty. The medical needs of the autistic child are likely to grow as the child ages, making long-term financial planning both essential and difficult (United States Government Printing Office, 2007).

The financial implications of autism were recognized at the national level well before the 2011 New York law. The Federal government began addressing the challenges faced by families struggling with autism and its associated costs as early as 2006. By March 2007, the Congressional Record shows that Senator Hillary Clinton introduced a bill to support "services for individuals with autism and their families." Under that bill, grants were to be provided to states from the federal government to sustain and promote services for families of people with autism (United States Government Printing Office, 2007). The New York law is therefore the product of sustained effort by policymakers and advocates at both the federal and state levels.

Conclusion and Recommendations