New Mexico Senate Passes Bill for Autism Insurance Coverage

The New Mexico state Senate has approved a bill that would prohibit health insurers from discriminating against patients on the basis of an autism spectrum disorder diagnosis. A copy of Senate Bill No. 197, passed by a 32-4 vote on Feb. 13, is available through the New Mexico Legislature website by clicking here and then clicking on the PDF document. Note that the bill does not specifically require insurers to cover certain therapies or services (such as Applied Behavior Analysis or occupational therapy). It says that insurance companies can't rule out such services because of a patient's autism diagnosis.

As The Las Cruces Sun-News notes in this article, an amendment to the bill made on the Senate floor prohibits experimental treatments from being covered; the newspaper reports this was made as a compromise with the insurance industry.

While the vote was overwhelming -- one state senator said there is a three-year wait for diagnostic services at the University of New Mexico Medical Center, then another long wait for treatment -- opponents noted its uncertain cost.

Of course, with debates about health care policy and insurance coverage, it's not a matter of costs going away -- it's a matter of who is bearing the costs, or in this case whether people with autism spectrum disorders (ASD) get access to services at all. A fiscal impact report on this bill stated:

[Department of Health] reports direct medical costs for a child with ASD average more than $29,000 per year and direct non-medical costs from $38,000 to $43,000 creating financial hardship for individuals and families whose insurance coverage excludes ASD.

In New Mexico, this scenario applies to approximately 2,000 children under 18 years old, according to the fiscal impact report.

It's quite early to mention the 2008 presidential campaign, but it's worth noting that New Mexico Governor Bill Richardson has declared his intention to seek the Democratic nomination (see his exploratory committee website with the definitive-sounding "richardsonforpresident.com"). So for autism advocates, the fate of this bill could be one way to gauge Richardson's views on autism issues. (Of course, that's if this bill wins approval by the New Mexico House of Representatives.)

The health insurance issue in other states

Other states have also looked at health insurance practices related to autism services. Recent Autism Bulletin coverage of health insurance and autism services:

A New York Assemblyman filed a bill to prohibit health insurers from discriminating against autism-related service requests. The bill filed in January also would exclude experimental treatments. See "New York State Bill Would Make Health Insurers Pay for Autism Services."

Also in January, a New Jersey court ruled that the administrator for state employees' health insurance acted illegally when it denied coverage for autism-related treatment to two children with ASD. See "N.J. Court Rulings: State Workers Health Insurance Covers Autism Services."

Tennessee passed legislation with a similar spirit to that cited in New Mexico. See "A Step Forward for Autism Treatment in Tennessee," from July 2006.