February 04, 2019

Autism Report shows improvements in access and coverage for Missouri consumers, with minimal impact to premiums

Missouri continues to see increases in access to autism services without a notable impact on health insurance premiums

Jefferson City, Mo– The eighth annual autism report from the Missouri Department of Insurance shows that nearly 3,700 individuals were treated for autism-related conditions in 2018, receiving nearly 85,000 autism treatments of which 51,223 were applied behavioral analysis (ABA) sessions covered under Missouri’s mandate. This number is up from 14,505 ABA sessions in 2013 (the first year these data were collected), which represents a 250 percent increase.

Using data supplied by health insurance companies, the report says, in terms of dollars, insurance claims for autism-related treatments totaled $16 million in 2018.  Of that amount $9.1 million was directed to ABA services.  However, in terms of the relation of autism treatments to overall health claims, autism treatments represent just 0.32 percent and 0.28 percent of total claims incurred in 2018. For each member month of autism coverage, total autism-related claims amounted to 90 cents, while the cost of ABA therapy amounted to 51 cents. 

“Missouri has successfully balanced the significant needs of families while maintaining affordable health insurance premiums, “said Chlora Lindley-Myers, Director of Insurance, Financial Institutions and Professional Registration. “This is evidence of what is possible when all interests come together to help solve problems for the families of our state.”

Other noteworthy findings from the department's report:

  • In 2018, nearly 98.5 percent of individual policies provided the coverage for autism. Across all market segments in the most recent reporting period, 99.8% of all insured individuals were covered for treatment associated with autism.
  • Just under 3,700 individuals diagnosed with an ASD submitted over 85,000 claims, of which 51,223 were ABA sessions. This number is up from 14,505 ABA sessions in 2013 (the first year these data were collected), which represents a 250 percent increase.[1]
  • ABA treatments comprised just over one half of all autism treatments provided in 2018.
  • The average monthly cost of treatment across all market segments was $398, compared to $341 in 2017.  Of that average monthly cost, ABA therapies accounted for $228.
  • While costs associated with autism-related treatment have risen during the years since the mandate was enacted, the fact that these costs remain near three-tenths of one percent of overall claim costs means this law continues to have little appreciable impact on insurance premiums. 
  • The first licenses for applied behavior analysis were issued in Missouri in December 2010.  As of mid-January 2018, 593 licenses had been issued, and an additional 84 persons obtained assistant behavior analyst licenses.  Of these, 492 behavior analyst licenses are still active, as are 40 assistant behavior analyst licenses.

Missouri's landmark autism law was passed by the Missouri General Assembly on a bipartisan basis and signed by the Governor in 2010.  

The Department of Insurance has extensive resources for families and health care providers on its website. Consumers and providers with complaints or questions are encouraged to call the department's Insurance Consumer Hotline at 800-726-7390 or file a complaint at insurance.mo.gov.

[1]The precise number of individuals seeking an ASD-related treatment is subject to some uncertainty.  Data submitted by some insurers in some years appeared to be anomalous.  The DIFP is currently subjecting this figure, as well as the overall data, to additional verification procedures.  When completed, the DIFP hopes estimates for the number of individuals seeking treatment for an ASD can be reported with greater certainty. More confidence exists for 2017 and 2018 data, such that the number of individuals seeking treatment for an ASD is reported for these two years.