A new law — signed by Gov. Kay Ivey just last week — requires that insurers provide coverage for autistic children 18 and younger to receive applied behavioral analysis therapy, or ABA therapy.
ABA therapy is not new — its methods were first introduced in studies as early as the '60s, according to Dr. John Rapp, director of Auburn University's ABA master's program — and Alabama is one of the last states to require some form of insurance coverage for its treatments.
"We're the 46th state in the union to provide mandated insurance coverage for autistic children," said Alabama Sen. Tom Whatley, who sponsored the bill in the Senate. "We went from doing nothing to probably being in the top 15 in the country because we have set an age limit of 18. There are only a few states with no age limit and many have an age limit of 9."
Whatley said he was opposed to having an age cap, but that the Legislature made that decision based on finances. The amount the new law will cost the state each year is estimated at about $11 million, said Whatley.
"Then, there's a cost we estimate to be less than $1 per month for every insurer," he said. "The deal is, yes there is a cost; yes it is a mandate, but if you help those children now, then when they're older, they'll be in the workforce, functioning, paying taxes, earning their own living, doing their own thing. So it's an either pay now or pay later type of thing. I think the better thing for children, families and our economy is to provide this therapy on the front end."
Rapp, director of the university's ABA program, said that ABA therapy is used to treat a number of disorders, but it is most popularly used to help people with autism spectrum disorder (ASD) overcome communication and socialization barriers as well as the need to display repetitive behaviors. There are specific interventions for each of those defining features of ASD, and the earlier autistic children receive treatment, the easier it is to change those behaviors, he said.
"Behavior continues to be changeable, but the research bears out that early intervention is the way to go," Rapp said. "(The new law) was something to behold, really. I think it's a very good starting place ... and I'm optimistic that a good percentage (of autistic children) can be in a good place by age 18."
The mandate will come into effect on Dec. 31, 2018, which will allow the state time to budget for its costs, Whatley said. It will include coverage in the insurance plans for state employees, education employees, Medicaid and companies with 51 employees or more.
Having ABA therapy now covered by insurance in Alabama may increase demand in the state for qualified therapists. Rapp said the students who come out of the ABA master's program have never had a problem getting employment, but giving them the opportunity to stay in Alabama to work would be nice.
"We oftentimes have them employed before they graduate, but demand in the field has been high," he said, adding that the field has seen growth for the last decade and continues to grow. "In any state that funding has emerged, demand is increasing."
The ABA program at Auburn University has been in place since 2003 and attracts students from all over the country, Rapp said.
"I'm looking forward to incentivizing them to stay in the state," he said. "We like to think we attract the strongest Alabama students who are interested in studying ABA, and we like to think we attract students from all over the country and internationally."