Advocates for Autism of Massachusetts

Autism Insurance, ARICA and the Health Connector Open Enrollment Information

January, 2015

General Information

ARICA is a law in Massachusetts which requires health insurers in Massachusetts to provide coverage for the diagnosis and treatment of Autism Spectrum Disorder, including, but not limited to, Applied Behavior Analysis (ABA) therapy. However this law only affects certain types of health care policies (private insurers, employees and retirees under the state plan, hospital service plans and HMOs), so coverage under ARICA depends on the type of policy you have. Self-funded plans and MassHealth are not subject to ARICA:

Self- funded plans - Many of the State’s largest employers provide coverage through self-funded plans. These plans are federally regulated, and not subject to State laws. If your plan is self-funded, your company may provide coverage under ARICA, and/or cover autism therapies, but it is not required. For people with autism who need ABA and other behavioral therapies, self-funded plans may not cover them.

MassHealth is also not subject to ARICA. MassHealth covers many treatments and services for people with autism, but does not cover ABA therapy, except under MassHealth’s Home and Community Based Services Autism waiver and under MassHealth’s 1115 Demonstration Project for children receiving early intervention from the Department of Public Health. This is expected to change sometime in 2015, but the details and timeframe for implementation are still being worked out.

The Health Connector currently has an Open Enrollment period, until February 15, 2015. During this Open Enrollment, people in Massachusetts have the opportunity to purchase private insurance policies through the Connector. These policies are subject to ARICA, and provide access to medically-necessary autism treatments, including ABA therapy that might not be covered by self-funded plans or MassHealth. If your current insurance doesn’t cover the autism therapies you need, you might want to consider purchasing an unsubsidized qualified health plan during this Open Enrollment. For many people, MassHealth Premium Assistance (PA) is available to cover the cost of purchasing these policies.

For additional information, including enrollment instructions, click here. (Word docx)

About Advocates for Autism for Massachusetts (AFAM)

Advocates for Autism of Massachusetts was formed in 2004 to address the need for public advocacy on behalf of individuals, families and professionals who have or deal with people with Autism Spectrum Disorder (ASD) which also encompasses Asperger's Syndrome and high-functioning Autism. The organization provides an important arena for mobilizing those of us who deal with ASD in our day-to-day lives as the most eloquent and persuasive spokespeople for our concerns. Our efforts focus not only on the State House but also on towns and city halls that also have responsibility for service delivery and funding.

Mission

Advocates for Autism of Massachusetts will strive to assure the human and civil rights of individuals of all ages across the entire Autism Spectrum and promote the availability of essential supports so that they may live fully and enjoy the same opportunities as other citizens of the Commonwealth. We will educate individuals with ASD, their families and other AFAM members/supporters to be effective, vigorous agents of change. Read more.

Action Alerts: Please visit the Government Affairs page.