Blue Cross and Blue Shield of Alabama says a new state mandate to cover autism therapy will apply to its group insurance plans covering about 160,000 employees in Alabama, plus some individual plans.
Parents and advocates who fought for the law said they are pleased and hope it establishes a foundation for wider coverage.
The mandate applies to companies with more than 50 employees that are not self-insured. For Blue Cross and Blue Shield, that means it applies to 1,100 companies, said Koko Mackin, vice president of communications for the company.
The mandate also applies to more than 9,000 individual Blue Cross and Blue Shield policies that were grandfathered under the federal Affordable Care Act. Those cover almost 18,000 people, Mackin said.
The mandate takes effect when plans renew after Oct. 1. It applies to autism therapy for children up to age 18.
Starting in 2019, the mandate in the law will also apply to insurance plans covering state employees and public education employees, as well as the Children's Health Insurance Plan, called ALL Kids, and Medicaid.
The Legislature passed the bill on Thursday, the next-to-last day of the session, and Gov. Kay Ivey signed it into law on Friday.
That followed a full-court press lobbying effort by parents and advocates, who repeatedly filled State House meeting rooms wearing "Autism Matters" T-shirts.
Among the regulars were Suzanne Dowling of Tuscaloosa and her son, Sam, who has autism. They won't directly benefit from the legislation. Sam is 25, beyond the age cap.
"We were there for future Sams," Suzanne Dowling said.
The mandate covers diagnosis and treatment of Autism Spectrum Disorder, including applied behavior analysis, called ABA.
Dowling said she had not heard of ABA when Sam was diagnosed 23 years ago. But she said Sam received effective therapies from an early age through the University of Alabama's psychology clinic and speech and hearing center. Suzanne Dowling is retired from the university and her husband, Rick, works there.
Sam was able to learn in a regular classroom through most of his school years, Dowling said. He graduated from high school and works part-time at the University of Alabama.
Dowling sees parents of young children with autism struggling for the normalcy others take for granted, things as simple as some quiet time at home and going to church. She said the insurance mandate is not a handout.
"These parents are asking that the premiums they pay cover something that is medically necessary for their child," Dowling said.
Bama Hager, policy and program director for the Autism Society of Alabama, said hundreds of Alabama families have had no access to ABA, which she said is the most commonly prescribed and medically necessary treatment for autism.
Advocates say ABA can be life-changing for some with autism, especially if received at early ages. Hager said ABA is not available in many areas because it's not covered by many insurance plans. Advocates expect that to change with the mandate.
Hager said a provision in the bill that covers therapy by telemedicine, done with video chat applications, should also substantially boost access.
Catey Hall and her husband moved to Birmingham because of the lack of autism therapy services for their son, Liam, in Gadsden.
Hall said Liam, 4, receives 30 minutes of ABA four days a week, down from five days a week because of the progress he's made.
Liam is fully verbal and will start kindergarten with his twin sister with little, if any, special help, Hall said.
"He's a completely different child and we credit that 100 percent to his early intervention," Hall said.
Hall said she and her husband don't have insurance coverage for ABA but have been able to afford it. She knows other families who can't or who have had to take extraordinary steps, like downsizing their home.
Autism Society Program Director Hager said the society was pleased overall with the legislation but that the age 18 cap was a disappointment.
Hager questioned whether it would significantly affect insurance costs because the most intensive years for therapy are typically at younger ages.
Hager's son, Henley, 17, has autism and can still benefit from ABA at specific times of transition, such as starting a new school year, Hager said. She noted that if her son had diabetes, asthma or cerebral palsy, there would be no age cutoff.
"I don't understand why his medically necessary therapy isn't covered after age 18," Hager said.
Suzanne Dowling said her Sam is quiet, keeps mostly to himself and lives at home. One interest Sam is not shy about is his love for the U.S. military, Dowling said. Today, she and Sam were at the VA Hospital in Tuscaloosa to watch Vietnam veterans pass by on their motorcycles on an annual trip to Washington for Memorial Day.
"Memorial Day and Veterans Day are as big to him as Christmas is to other people," Dowling said. She said Sam roots for Army and Navy in football in a Crimson Tide household.
Sam's love for the military helped him connect with some of the lawmakers at the State House. Suzanne said the force of the grassroots campaign in Montgomery was remarkable.
"I would never have thought 23 years ago there would be that much of a movement in Alabama for autism," she said.