He is. But his step, while important, also doesn’t take him very far. It continues to leave him, autistic children and their federally employed parents behind the curve.
OPM, after excluding ABA from FEHBP as an educational service, will allow insurance companies to cover it as a medical treatment next year. Open season, during which employees can change insurance plans, ends Dec. 10.
“This decision by OPM, however, is only a partial victory, since they only allowed rather than required the insurance companies to cover autism treatment,” said J. David Cox, president of the American Federation of Government Employees, which has pushed for ABA coverage.
The problem for families is many insurance plans still will not cover ABA. OPM does not mandate it. As a result, coverage of ABA will be available in some places but not others. It will not be covered, for example, in the District, Maryland and Virginia, except in the Hampton Roads and Richmond areas, according to Autism Speaks, a science and advocacy organization.
“Out of 230 participating health plans, 67 chose to offer the ABA benefit in 2013,” according to the organization. ABA coverage will be available everywhere in only three states, Arkansas, Minnesota and New Mexico. It will be available in parts of 19 others. Everywhere else, parents and their children will be out of luck.
OPM Director John Berry said federal families “should know that all FEHB carriers currently cover speech, occupational and physical therapy, as well as mental health treatment and medications for children with autism. This decision on ABA coverage offers an opportunity for the provider base to grow and ABA coverage to expand.”
Until then, many employees will have to pay for coverage personally, as some have been doing
“The OPM decision that ABA should be covered as a medical therapy felt like a victory,” said Katy Scheflen, a Justice Department lawyer. “ The disability community was excited, I was excited — words like ‘landmark decision’ were tossed around in the media. I truly believed that come 2013, things would change and that for the first time in years, I would not spend countless hours thinking about how I was going to pay the therapy bills. I believed that I could stop worrying about asking family and family friends for financial help and wondering how much more I could pull out of my retirement account to get through another year of therapy for my daughter. It felt like this particular battle was over and we had won.
“Unfortunately, it turns out that there is a very big difference between telling insurance companies that they may stop discriminating against families struggling with autism and that they must stop discriminating against them. And make no mistake about it — it is discrimination,” she continued. “In retrospect, I guess I was naive to expect that, still given a choice by OPM, insurance companies would choose to do the right thing. At the end of the day, the OPM decision changed nothing for my family, other than to give us false hope. To say it is disappointing is an understatement — it is heartbreaking.”