Terri Farrell Autism Insurance Resource Center UMass Medical School/Shriver
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1 Terri Farrell Autism Insurance Resource Center UMass Medical School/Shriver Joanne Bayliss Massachusetts Department of Developmental Services Copyright 2016 Autism Insurance Resource Center All Rights Reserved
2 Context Impact of the Affordable Care Act Keeping a Dependent on a Parent s Policy ARICA and Employer Sponsored Insurance The Health Connector Premium Assistance Copyright 2017 Autism Insurance Resource Center All Rights Reserved 2
3 But to raise a child with ASD to be an employed, included, safe, and productive adult takes something like a village, 2 small towns, a midsized city, a chapter of the Hells Angels, half a dozen communes, a large trailer park, an on-call medical team, and a fleet of vehicles Peter Gerhardt Associates, LLC 3 Copyright 2017 Autism Insurance Resource Center All Rights Reserved
4 A Resource for Consumers, Providers, Employers, and Educators on Issues Related to Medical Insurance for Autism Treatment Information and referral by phone/ on issues related to Insurance Coverage for Autism-Related Treatments and Services Access to documents including Legislation, FAQ s, Agency Bulletins, etc. Support for Employers and Individuals covered by Self- Funded (ERISA) Plans Webinars on Insurance Laws and Related Topics Focus Groups and Trainings Copyright 2017 Autism Insurance Resource Center All Rights Reserved 4
5 ASAN Policy Brief, September, 2013 The Affordable Care Act is the most significant change to our nation s health insurance system since the creation of the Medicare and Medicaid programs. As the ACA comes into full implementation in 2014, the disability community will have access to meaningful opportunities to enhance access to and the quality of healthcare service provision ASAN-policy-brief.pdf Copyright 2017 Autism Insurance Resource Center All Rights Reserved 5
![... Access to the exchange system and the availability of [subsidies] up to 400% of the federal poverty level may significantly reduce existing work disincentives.](/docs-images/77/76105205/images/6-2.jpg "... the availability of an affordable private insurance alternative offers significant opportunities for enhanced workforce participation. http://autisticadvocacy.")
6 ... Access to the exchange system and the availability of [subsidies] up to 400% of the federal poverty level may significantly reduce existing work disincentives.... the availability of an affordable private insurance alternative offers significant opportunities for enhanced workforce participation. ASAN-policy-brief.pdf Copyright 2017 Autism Insurance Resource Center All Rights Reserved 6
7 More individuals will be able to purchase policies through the Connector. Premium Assistance can subsidize cost of policies for people under 21. Subsidies are available for people with incomes <400% of FPL. Private policies purchased through the Connector are subject to ARICA. Copyright 2017 Autism Insurance Resource Center All Rights Reserved 7
8 Under the ACA, children can remain under a parent s policy until age 26. Disabled dependents can usually remain on a parent s policy after age 26. Parents need to apply to their employer for this coverage advised to do so well before dependent turns 26. After a dependent turns 26 they are not able to be added back to a parent s policy, regardless of disability. Copyright 2017 Autism Insurance Resource Center All Rights Reserved 8
9 Does this just apply to people with ASD? If my child has a job that provides, insurance, can I put them back on my policy if they lose their job? My child is older than 26 what are my options? Copyright 2017 Autism Insurance Resource Center All Rights Reserved 9
10 ARICA (An Act Relative to Insurance Coverage for Autism), is a law enacted in 2010 requiring private insurance to cover medically necessary treatment for autism. Provides coverage for habilitative and rehabilitative care, including, but not limited to, Applied Behavior Analysis (ABA) therapy. Provides coverage for Pharmacy, Psychiatric, Psychological, and Therapeutic Care. Details are available in FAQ s on our website. Copyright 2017 Autism Insurance Resource Center All Rights Reserved 10
11 Fully Funded Private Plans - subject to ARICA. Self-Funded Private MassHealth Public Self-Funded Plans Not subject to ARICA. Some self-funded plans include ARICA benefits, but many do not. Fully Funded Private Mass Health Not subject to ARICA, but covers many of the same benefits. Copyright 2017 Autism Insurance Resource Center All Rights Reserved 11
12 Under the ACA, employees have the option to purchase policies through the Exchange ( The Connector ), thus gaining access to ARICA benefits. This is a major change. Families also have the option to purchase a policy through the Connector for a single child, which can be much less expensive. Copyright 2017 Autism Insurance Resource Center All Rights Reserved 12
13 Does ARICA cover autism treatments for adults? Can I purchase a policy from the Health Connector that will provide access to ARICA benefits for my child? Can my child receive MassHealth and also have private insurance? If so, which plan will be primary? Copyright 2017 Autism Insurance Resource Center All Rights Reserved 13
14 The Health Connector is Massachusetts' health insurance Marketplace where people can shop among the state's leading health insurance carriers. Unsubsidized Qualified Health Plan (QHP) policies purchased from the Connector are subject to ARICA. Policies can only be purchased during specific Open Enrollment periods. Copyright 2017 Autism Insurance Resource Center All Rights Reserved 14
15 Premium Assistance is a program within MassHealth, and is available for people who are covered under Standard or CommonHealth. For people with Employer Sponsored Insurance and MassHealth, Premium Assistance may reimburse the cost of the Employer s insurance. This can be a valuable benefit for a disabled adult who receives MassHealth, but remains on their family s policy. Copyright 2017 Autism Insurance Resource Center All Rights Reserved 15
16 Will MassHealth provide Premium Assistance for private insurance purchased through the Connector (versus Employer Sponsored Insurance)? What happens when a parent gets Medicare? What steps should I be taking now? Copyright 2017 Autism Insurance Resource Center All Rights Reserved 16
17 Contact Information Acknowledgments MA Developmental Disabilities Council Nancy Lurie Marks Family Foundation Doug Flutie Jr. Foundation for Autism Autism Speaks MA Department of Developmental Services (DDS), Department of Public Health (DPH), Department of Elementary and Secondary Education (DESE) INDEX/UMassMedical School Copyright 2017 Autism Insurance Resource Center All Rights Reserved 17
Terri Farrell Project Director, Autism Insurance Resource Center, INDEX UMass Medical School/EK Shriver Center
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