Understanding Autism Benefits in New York

January 31, 2024

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Autism is a condition that affects millions of people worldwide, with varying degrees of severity. In the state of New York, there are several programs and benefits available to individuals diagnosed with autism and their families. This blog post aims to provide an overview of these benefits, ranging from insurance coverage to special healthcare needs programs.

New York’s Autism Mandate

The state of New York has a specific mandate concerning autism. According to the American Speech-Language-Hearing Association, the mandate requires every policy which provides physician services, medical, major medical, or similar comprehensive-type health services or contracts to cover the screening, diagnosis, and treatment of autism spectrum disorders. This mandate ensures that those with autism have access to the necessary healthcare services.

Early Intervention Programs

The New York Department of Health offers early intervention programs for children with autism. These programs aim to improve language, social, and adaptive functioning, and reduce inappropriate behaviors. Early identification and referral of children with autism to these programs can lead to significantly improved developmental outcomes.

Special Health Care Needs Program

In addition to the early intervention programs, the Department of Health also provides family support for children and youth with special health care needs. This program connects families to health and community resources and provides community support and information. Conditions covered by this program include but are not limited to autism spectrum disorder.

Caregiver Support

New York also offers financial support for caregivers. If your adult child is over the age of 21 and covered by Medicaid, you can get paid to care for them through the New York State Department of Health. This can provide significant financial relief for families caring for an adult with autism.

Social Security Disability Benefits

For families struggling to make ends meet, Social Security Disability Insurance may be a viable option. If your child has autism, they may be eligible for Supplemental Security Income (SSI) benefits. It’s important to know that the amount of benefits a child with autism can receive from SSI varies.

Consumer Directed Personal Assistance Program (CDPAP)

The CDPAP is a New York Medicaid program that allows individuals with disabilities to direct their own care. Many families are not aware that they can use this program to manage the care of a loved one with autism.

CDPAP caregivers provide help with daily living activities for disabled individuals. This allows the individual on the program to receive care based on their special needs.

Applied Behavior Analysis (ABA) and Insurance Coverage

Applied Behavior Analysis (ABA) is a type of therapy that improves social, communication, and learning skills through positive reinforcement. It’s one of the most widely accepted therapies for children with autism spectrum disorder. In New York, ABA therapy is covered by insurance under the state’s autism mandate.

The mandate requires health insurance policies to provide coverage for the screening, diagnosis, and treatment of autism spectrum disorders. This includes ABA therapy, which is considered an evidence-based best practice treatment by the US Surgeon General and the American Psychological Association.

Insurance coverage for ABA therapy in New York applies to fully insured group and individual health plans. However, self-insured plans (those funded by an employer rather than purchased from an insurance company) are not required by state law to provide this coverage, although some may choose to do so voluntarily.

The amount of coverage can vary depending on the family member’s specific insurance plan. Some plans may have limits on the number of hours of ABA therapy covered per week or the total dollar amount covered per year. It’s important for families to thoroughly review their insurance policy or speak with an insurance representative to understand what coverage is available.

While insurance can help cover the cost of ABA therapy, it’s also crucial to note that this therapy should be part of a comprehensive treatment plan. It’s often most effective when it’s combined with other therapies, educational efforts, and community support.

Navigating health insurance can be challenging, but resources are available to help. Many providers have dedicated staff who can assist with insurance questions, and advocacy organizations can also provide guidance and resources.

In conclusion, ABA therapy is a critical component of autism treatment in New York, and it’s supported by state legislation requiring insurance coverage. This ensures that parents of individuals diagnosed with autism have access to this potentially life-changing therapy.