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Parents: Autism Treatment in NC is Uphill Battle

Nashonda Cooke's daughter, above, is on the autism spectrum. Cooke says she often pays for therapy out of pocket when insurance doesn't pay. (Photo courtesy of Cooke)
Nashonda Cooke's daughter, above, is on the autism spectrum. Cooke says she often pays for therapy out of pocket when insurance doesn't pay. (Photo courtesy of Cooke)
April 12, 2017

RALEIGH, N.C. - North Carolina is one of 45 states that require insurance policies to cover applied behavior analysis therapies for people on the autism spectrum. However, advocates for people with autism say there's a catch.

Employer-sponsored health plans are required to cover it, but the state specifically exempts individual policies purchased on the Health Exchange. Lorri Unumb, vice president for state government affairs with the group Autism Speaks, said the exception was made because of a requirement under the Affordable Care Act for states to fund coverage mandates.

"To avoid the possibility of having to absorb the cost of this mandated autism benefit," she said, "the North Carolina Legislature simply carved out plans sold under the Affordable Care Act."

Lawmakers who supported excluding ABA therapy said cost to the state was a concern. According to the Centers for Disease Control and Prevention, about one in 58 children has been diagnosed with an Autism Spectrum Disorder. On average, medical expenses for people with autism are four to six times higher than others.

April is National Autism Awareness Month.

Nashonda Cooke of Durham has a daughter with autism. While her daughter has coverage through her father's health insurance at work, she said it's still difficult to get timely care.

"So, I do absolutely everything I can," Cooke said. "I don't even wait for insurance, I pay out of my pocket. I can't wait. At one point for services, she was on a 2 1/2-year waiting list, and this was when she was in kindergarten."

Cooke, a teacher who also works with children on the autism spectrum, said she understands the value of therapy, both as a mother and someone with a master's degree in education.

"I almost feel like maybe that's why I got the experience as a teacher before I became a mother of a child with autism," . I saw the difference it made in the classroom."

Numerous studies have shown that when offered at a young age, autism therapies can significantly improve a child's ability to function, in school and later in his or her career. One study published in the journal Pediatrics indicated ABA even can raise the IQ of a child on the spectrum. The study is online at autismspeaks.org.

Stephanie Carson, Public News Service - NC