Gov. Shapiro announces rules to expand insurance access for people with autism

People with autism will soon be able to access expanded insurance coverage in Pennsylvania, Gov. Josh Shapiro announced at a press conference on Wednesday.

As of Jan. 1, 2024, the state will mandate that health insurers operating in Pennsylvania cover autism services in a way that complies with the state’s mental health parity laws. For too long, Shapiro said, patients have faced higher co-pays or coverage denials because some insurers would only pay for physical health-related services for people with autism.

That refusal to treat autism under the umbrella of mental health often left Pennsylvanians without needed services, including social skills training, behavioral support, and mental health counseling, the governor said. Autism spectrum disorder is a developmental disability that can present as a wide range of challenges with social skills, speech, and nonverbal communication. According to the U.S. Centers for Disease Control and Prevention, about one in 36 children has been diagnosed with autism spectrum disorder in the United States.

Approximately 55,000 Pennsylvanians are diagnosed with autism, according to Shapiro.

“To everyone in the autism community, if you are getting denials for autism services or you are experiencing higher co-pays than you normally do, you need to know we got your back,” Shapiro, a Democrat, said during the press conference at Drexel University in Philadelphia.

On Nov. 4, the Pennsylvania Insurance Department published a notice informing insurers that, by the new year, they would need to fairly cover mental health-related services for people with autism and that coverage must comply with the state’s Mental Health Parity and Addiction Equity Act of 2008. That law stipulates that insurers cannot charge individuals more for mental health services than they do for physical health care.

Michael Alos, who received an autism diagnosis at the age of 50, said the change is a crucial one that will lead to life-changing care for children and adults with autism.

“While I’m happy with who I am and the life I have today, I experienced unnecessary struggles and hardships that I might not have experienced if I had been diagnosed in childhood, and if the treatment options were different in Pennsylvania,” Alos said at the press conference.

Rep. Jessica Benham, a Democratic legislator who refers to herself as the first openly autistic lawmaker in Pennsylvania, said the expanded coverage will lead to a better quality of life for people with autism.

“As an adult, when I went to the doctor, my doctor previously could not bill my insurance under an autism diagnosis for services that I was receiving because autism, according to my insurance plan, was only covered for those under the age of 21,” Benham said during the press conference. “Now, since I have co-occurring diagnoses, I could still get services but others have struggled to receive that same care.”

Drexel University, where the press conference was held, is home to the A.J. Drexel Autism Institute, which partners with the state’s Autism Services, Education, Resources and Training Collaborative. That group works to improve the quality of services for people with autism in Pennsylvania, among other initiatives.

For support with insurance coverage of autism-related services, Pennsylvanians can contact a new state hotline at 1-877-881-6388. Additional information regarding the insurance changes can be found at pa.gov/autism.