Could Michigan be the next state to mandate insurance coverage for autism?

Several autism advocacy groups and handfuls of activist parents from across the nation think so, as a lawsuit against the state’s largest insurer to force it to pay for autism treatments moves forward in federal court in Detroit and as state lawmakers re-introduce legislation to do the same.

The tide is changing nationally: Eight states have enacted legislation in the last two years to require insurance companies to cover autism treatments. They are: Arizona, Connecticut, Florida, Illinois, Louisiana, Pennsylvania, South Carolina and Texas. Florida’s law takes effect April 1, making it the first in the nation.

“We know that with early intervention all children are helped. Not everyone with chemotherapy gets better. With autism, half will improve and be mainstreamed,;the other half will make improvements where they won’t have to be institutionalized,” said Elizabeth Emken of Autism Speaks, a national advocacy group that has undertaken autism insurance reform in all 50 states.

Most states, including Michigan, do not require insurance companies to cover treatments and services for autism, a neurological disorder affecting 1 in 150 children in the United States.

In the absence of coverage, families pay upwards of $10,000 to $50,000 per year for treatment or their children go without at a time when autism experts say early intervention is critical.

Dan Meyers is convinced autism therapy is working for his son Jacob, 5. Jacob communicated with his family by making mostly grunts and moans. But after four years of weekly applied behavioral therapy, Jacob uses words and now can speak in sentences.

Doctors have recommended that Jacob receive 20 hours a week of therapy that Meyers says would cost him $75,000 a year. What Meyer, an IT consultant, can afford is about two hours a week, which costs the Allen Park father $800 a month.

Lawmakers in Lansing have tried more than once to get such coverage mandated. Three bills were introduced in the 2007-08 session and died. They all were reintroduced in February and March in the Michigan House and Senate.

Typically, insurers in Michigan have been resistant to mandates. Rick Murdock with the Michigan Association of Health Plans, which represents 20 health plans that insure 2.4 million Michigan residents, said his group has studied the proposed legislation.

“The bills are so wide open it doesn’t really describe the benefits or whether or not there is evidence behind the services that would be provided,” Murdock said. “So we’d be looking for language that would require the services to be based upon evidence-based medicine … If there is evidence to demonstrate that it works, then we are willing to work with it.”

Blue Cross Blue Shield of Michigan, the state’s largest insurer, says it opposes the bills because they are government mandates — not because they are about autism.

“It’s a mandate that prevents purchasers from having flexibility in choices in the benefits they provide,” spokeswoman Helen Stojic said, adding that plan purchasers would have to absorb the entire cost of the service, which would drive up costs considerably.

Christopher Johns of Warren is suing Blue Cross Blue Shield of Michigan to force it to pay for applied behavioral therapy for his 7-year-old son who is autistic. Blue Cross denied the claim, saying the treatment is experimental and not covered.

Johns is seeking a class action status in the case in U.S. District Court to help get coverage for all families in Michigan. The Michigan Public Schools Autism Prevalence Report estimates 13,839 children in Michigan had some form of autism as of 2008. That number was 7,259 in 2003.

Emken, of Autism Speaks, says studies by her group and others have shown an average of a one percent increase in premiums when autism coverage is added to policies. She is working with Michigan lawmakers to get the bills passed.

“It takes a lot of education to get this passed. We rarely succeed in the first year. That first year is about educating the legislature and the public,” she said.

State Sen. Tupac Hunter D-Detroit, the sponsor behind the senate version, said he is renewing his fight to get autism coverage because families are going bankrupt trying to help their children

Hunter is willing to impose limits on the bill and work with the insurance industry. Treating autism now will help reduce the state’s health care costs in the long run, he said.

“We need to focus on the issue and commit ourselves to doing the right thing here,” he said. “Michigan needs to get on the same page.”