County Moves to Offer Insurance for Autism

Washtenaw County employees will soon be able to get health insurance coverage for the treatment of autism, following action at the county board’s March 19, 2014 meeting. In a unanimous vote, the board gave initial approval that would authorize adding a Autism Spectrum Disorder (ASD) rider to existing active employee and retiree benefits. [.pdf of staff memo and resolution]

Adding the rider would cost the county an estimated $182,589 this year, according to staff – to be paid to Blue Cross Blue Shield of Michigan. To cover that cost, each county department will be charged on a per-employee basis. In addition, the county will pay for claims made by employees for this benefit, with the assumption that most if not all claims would be reimbursed by the state.

The board has been discussing this possibility for several months. At its Jan. 22, 2014 meeting, the board received a staff presentation about the possibility of offering such coverage. Colleen Allen, CEO of the Autism Alliance of Michigan, attended that meeting to answer questions and advocate for coverage. The board created a committee to explore the cost to the county for providing employee health insurance coverage for autism. Committee members were Felicia Brabec (D-District 4), Andy LaBarre (D-District 7) and Ronnie Peterson (D-District 6). The committee’s charge was to (1) investigate the cost and sustainability of coverage of autism spectrum disorders; and (2) recommend a policy providing and funding coverage if the state reimbursement fund is exhausted.

The federal Mental Health Parity & Addiction Equity Act of 2008 mandates that any group plan with 50 or more members – like Washtenaw County government – must offer both medical and mental health benefits. Under more recent federal health care reform, there’s been an expansion of benefits, and mental health benefits are considered a mandatory part of basic health care, starting this year. However, autism isn’t included as part of that mental health mandate.

On the state level, in October 2012 a state of Michigan mandate took effect stating that all fully insured plans must provide coverage for the diagnosis and treatment of autism spectrum disorders (ASD). The county is not a fully insured plan, however. Because the county is self-funded, it was exempt from this state mandate.

The costs of treatment are estimated to be about $60,000 a year to cover a child with autism. The state of Michigan has made coverage a priority, and has started setting aside funds to reimburse organizations that provide coverage. In fiscal year 2012-13, $15 million was made available, with an additional $11  million in fiscal 2013-14. Of that, only about $500,000 has been expended on reimbursements. The program is handled by the Michigan Dept. of Insurance and Financial Services.

The state program provides for reimbursement of up to $50,000 per year per child between the ages of 0 to 6, up to $40,000 per year from ages 7-12, and up to $30,000 per year for ages 13-18.

County staff have estimated that offering the coverage would result in up to a 5% increase in medical expenses, or up to $1 million annually. This year, medical expenses are budgeted at about $20 million. The county is expected to be fully reimbursed by the state of Michigan for the amounts that are allowed under the autism program.

The resolution given initial approval on March 19 included two resolved clauses:

NOW THEREFORE BE IT RESOLVED that the Washtenaw County Board of Commissioners authorizes the implementation of the Autism Spectrum Disorder (ADS) rider to existing active and retiree as soon as feasibly possible through Blue Cross/Blue Shield of Michigan, providing mental health and physical health parity.

BE IT FURTHER RESOLVED that Washtenaw County commits to a review of claims paid and/or reimbursed on an annual basis as our individual experience is not yet known. Such review would occur prior to the annual review process with Blue Cross/Blue Shield to determine if such benefit (rider) would be continued in the next year of benefits.

This brief was filed from the boardroom of the county administration building at 220 N. Main St. in Ann Arbor. A more detailed report will follow: [link]