From the time Addie Bowden was diagnosed with autism, just before her third birthday, until she started school, intensive, specialized therapy helped her cope with her disorder and develop the skills she needed. When she reached school, however, the therapy wasn’t available, and she quickly regressed.
Parents of children with autism face this dilemma all the time in Maine, as private insurers are required to cover autism only through the age of 5.
After that, some qualify for coverage under MaineCare. Some are fortunate enough to have a program offered through their local school.
Others take matters into their own hands. Addie’s mom, Heidi Bowden, received the education and training she needed to provide the therapy herself, two hours a day, Monday through Friday, for three years, out of a makeshift classroom in an Augusta church.
Many parents, however, don’t qualify for coverage, don’t have a quality school-based option and can’t dedicate the enormous amount of time it takes to do what Bowden did. As a result, their children suffer and struggle to move forward.
Keep private insurers involved
That’s why Maine should extend the age limit for coverage under private insurers, and make sure that the rising number of Maine kids with autism get the level of care they need.
A bill now before the Legislature, L.D. 347, would do just that.
The original version of the bill, introduced in the first part of the session in 2013, would have required private insurers to provide coverage for autism spectrum disorders through age 21. The amended bill out of the Insurance and Financial Services Committee, however, extends coverage only through age 10.
That’s an improvement over the coverage provided now, but it’s not enough, and not just because autism should be covered the same as any other disorder or ailment.
According to the Centers for Disease Control and Prevention a diagnosis of autistic disorder, on average, comes at age 4.
For Asperger’s, a disorder on the less severe side of the autism disorder spectrum, diagnosis typically comes at around age 6. In rural areas, diagnosis may be delayed further.
In Maine, that means coverage is ending just as, or even before, the problem is identified and therapy is started. And, as the Bowdens found out, the costs of stopping treatment are immense, to society as a whole as well as to the child.
Without appropriate treatment, autism has a lifetime societal cost of $3.2 million per child, according to a 2007 study.
Most of those costs are nonmedical, and most are incurred during adulthood, because of the increasing cost of housing and other living expenses.
But the more integrated and independent a person with autism becomes, the lower those costs get. And it is the proper, comprehensive behavioral therapy – done consistently from an early age – that pushes people with autism in that direction.
There is a slight cost to expanding coverage, in the form of higher premiums to be paid by everyone, as well as the higher cost of providing coverage to state employees.
Those costs are minimal, however, and they are offset by the reduced long-term costs of caring for people with autism.
There is also a relatively small number of people who would be able to transfer their care off MaineCare and onto private insurance if the coverage is changed, further lessening the burden on taxpayers.
More than that, extending coverage would mean that more Maine children have access to the kind of care received by Addie Bowden. She is now a student in Augusta public schools, according to her mom, who is now the executive director of Maine Autism Alliance.
The younger Bowden, who was non-verbal when she was diagnosed, now splits her time between special education and mainstream classrooms.
She plays in the band and takes karate. Last year, she was an honorary page at the State House.
That’s the kind of story every parent dealing with autism should have.