The recently enacted autism insurance legislation, also known as ARICA, requires some private insurance policies and the Group Insurance Commission (GIC) to provide coverage for the diagnosis and treatment of Autism Spectrum Disorder. Information about the law and which insurances must comply with the law can be found at http://www.disabilityinfo.org/arica and www.mass.gov/doi. Additional information can also be obtained by contacting the Autism Insurance Resource Center at New England INDEX/UMASS Medical School Shriver Center - 1-800-642-0249.
MassHealth
MassHealth programs are not subject to the new Autism law but it may be helpful to know the following.
MassHealth can pay for co-pays and deductibles for ARICA mandated treatment covered by private insurance only if the treatment is a service covered by MassHealth.
The Premium Assistance program may enable families to obtain CommonHealth for a child who does not have MassHealth in place.
Children under 21 with MassHealth with Autism Spectrum Disorders who also have a co-existing psychiatric disorder may be eligible for a range of home-based services through the Children's Behavioral Health Initiative (CBHI). For more information, see: www.masspartnership.com or www.mass.gov/masshealth/childbehavioralhealth. This may present an option for children who do not have access to a private insurance that complies with the ARICA mandate.
MassHealth Enrollment: 888-665-9993 or www.mass.gov/masshealth. One can also apply for MassHealth by contacting the Health Care for All Helpline: 1-800-272-4232. (See also www.hcfama.org/helpline.) Information about specific MassHealth programs can be found at www.massresources.org.
MassHealth Standard and CommonHealth
Premium Assistance Program (MSCPA)
Massachusetts has a premium assistance program. Seven types of MassHealth provide premium assistance toward the cost of an individual or family's private insurance plan when the plan meets the state standard for minimal creditable coverage. Premium Assistance may make it cost effective for families to apply for CommonHealth for their individual with an Autism Spectrum Disorder if they are not eligible for MassHealth Standard Disabled. Premium assistance from each family member's MassHealth can contribute to the cost of the family's private insurance premium. This program also enables many families who do not have have private insurance to obtain it. (See FY11 Premium Assistance Rates below.)
| FY11 | |
|---|---|
| Partnership (adults) | $150 |
| Family Assistance (children) | $279 |
| Standard | $349 |
| Essential | $409 |
| CommonHealth | $960 |
| HIV | $1,392 |
| Standard Disabled | $1,173 |
Premium assistance can reimburse families toward the cost of employer-sponsored insurance, private insurance, and Commonwealth Choice.
If someone is trying to access employer-sponsored insurance outside an enrollment period, the premium assistance program may be able to create a "qualifying event" which would enable this to happen. (The premium assistance program cannot create a "qualifying event" for insurance options with Commonwealth Choice.
Most families will want to contact the premium assistance program to find out how much CommonHealth will cost before they decide to apply. The CommonHealth program does not save every family money - this must be evaluated on a case by case basis by looking at the cost of CommonHealth, how much the private insurance premium is, the family's out-of-pocket medical costs, and the services that CommonHealth will pay for. For more information about the program and to request an application, contact 1-800-862-4840, x7.
Commonwealth Choice
Commonwealth Choice offers private insurance options for individuals, families, and employers who do not have access to employer-sponsored insurance. Insurance programs through Commonwealth Choice meet the state standard for "minimum creditable coverage" and are eligible for reimbursement through the Premium Assistance Program. All Commonwealth Choice options are also fully insured. Commonwealth Choice helps you to compare plans and prices. It is important to know that the enrollment period for this is between July 1st and August 15th, unless you meet specific conditions. For more information, see: www.mahealthconnector.org or contact at 1-877-623-6765.
Autism Waiver Program
The Massachusetts Children's Autism Medicaid Waiver serves a limited number of children under age 9 who have MassHealth Standard. This program has specific application windows. Contact DDS for more information.
Other Useful Information
Many private insurance options have statutes or policies that enable them to cover disabled adults as part of their family's plan beyond the age of 26. Doing so enables the parents to receive premium assistance from their son or daughter's MassHealth. More information about this can be obtained by calling the Division of Insurance Consumer Service Helpline: 617-521-7794; www.mass.gov/doi.
Individuals with MassHealth who also have Medicare may or may not be eligible for premium assistance. For more information about this, contact the premium assistance program.
