Having a child with autism isn’t easy. Having autism isn’t any easier. It wasn’t so long ago that many children were falling through the cracks at school, being overlooked as shy or quiet, when in fact several had a diagnosable disorder and could have received assistance to help them acclimate to social demands. But that was then and this is now and parallel to advances in diagnosing children with autism, services continue to grow. Further, certain services that were once too costly for too many are now provided for through insurance. California, like 27 other states that now offers autism insurance coverage for applied behavior analysis (ABA) therapy through its state exchange, the insurance marketplace created as a result of the Affordable Care Act (ACA). California’s autism insurance mandate (SB 946), implemented on July 1, 2012, requires most health plans to cover applied behavior analysis therapy for individuals with autism spectrum disorder (ASD).

Bryce Miler, director of contracts at the Center for Autism and Related Disorders (CARD), will be hosting a free two-hour workshop, “California Insurance Funding for Autism,” in Thousand Oaks this Saturday, 10 a.m. to noon, at the CARD treatment center in Thousand Oaks, located at 325 E. Hillcrest Drive, suite 140. The workshop will help parents navigate through the insurance coverage process; plus, parents will learn what must be covered under California law and the most effective way to access coverage. Attendees must register by the morning of the event with d.plump@centerforautism.com.

Miler spoke with the VCReporter this week about autism and the changing face of insurance coverage.

VCReporter: How many children are diagnosed with autism every year in the state of California? In the U.S.?
According to the Centers for Disease Control and Prevention, one in 88 children in America is diagnosed with autism. If you apply that number to new births per year that gives an estimate of how many children are diagnosed. About 500,000 babies are born per year in California, so that means that about 5,600 of them will later be diagnosed with ASD. For the U.S., there are about 4 million births per year, so one out of 88 for that works out to be about 45,400 per year that will later be diagnosed with ASD.

What are symptoms of autism? What are the youngest age and oldest age for diagnosis, typically?
Significant challenges with social communication and restricted repetitive behaviors that lead to clinically significant negative effects on quality of life. Children are usually diagnosed around 3 to 4 years old, but they can and should be screened as early as 18 months. Tragically many children with ASD are not diagnosed until they are 5 to 7 years old.

Prior to the Affordable Care Act, what services had been available to parents with insurance? Without insurance?
Since the California insurance mandate to cover ABA began on 7-1-2012, there has been widespread coverage for ABA therapy; however, many employer-sponsored health plans were/are exempt from the requirement to cover ABA. When patients do not have insurance coverage for ABA, they can request services from their local regional center; however, some California residents will not qualify for services. The ACA does change the coverage picture for Californians with modest means who may now be able to buy more affordable coverage then they had access to in the past.

What will insurance companies now cover that they hadn’t before?
The only recent change (resulting from the ACA exchange plans) is that patients can buy plans under Covered California and possibly qualify for a subsidy to assist with the insurance premiums. These plans do cover ABA therapy.

How does treatment help children with autism? Does it cure them?
Scientifically supported treatments based on applied behavior analysis (ABA) produce substantial, lasting improvements in children’s ability to communicate, play, make friends and generally function more independently. ABA treatment teaches skills across all areas of deficits that a child suffers from, with the goal of removing deficits entirely. A substantial minority of children who receive ABA treatment starting in the early intervention period, consisting of 30 or more hours of one-to-one treatment per week, and continuing for two or more years, end up having no clinically significant deficits when they are done with treatment. CARD refers to this outcome as recovery from autism. The majority of children with ASD do not recover, but all children who receive top-quality ABA treatment learn a substantial amount of skills that help them live more independent, happy, fulfilling lives.

What is the best plan of action for any parent who thinks his or her child may have autism? For a parent who has a child diagnosed with autism?
Any parent who is concerned about the rate of their child’s development should take their child to a pediatrician or psychologist for an autism screening. If there is any further concern, the child should see a medical doctor or psychologist who specializes in diagnosing autism. The key is to begin the screening process as young as possible.