The New Jersey Supreme Court has ordered a state health insurance plan for state government workers to pay for autism-related services for the young child of a state employee.
The ruling handed down on September 12 upholds an appeals court ruling from January 2007 which ordered the state's health insurance administrators to pay for services such as speech therapy and occupational therapy, illegally denied in the case of Jacob Micheletti. The court said it was illegal to discriminate against someone with autism, which the court described as a "biologically based mental illness." Read more explanation of that case Jacob Micheletti v. State Health Benefits Commission and the court decision here.
The Sept. 12 ruling, which you can find via the New Jersey courts website, is interesting because it specifically orders the state to pay out invoices for services including speech therapy, occupational therapy and Applied Behavioral Analysis/Verbal Behavior Therapy. My reading of the earlier court ruling didn't mention ABA specifically.
The ruling will have a practical impact for the Micheletti family: an estimated $35,000 per year for autism-related services for their son who is five years old, according to a story in the Star-Ledger of Newark. This figure is, of course, not new to families working to assemble a schedule of services for their young children with autism. Whether and how generally this ruling gets applied to other state workers is a matter of debate, the newspaper reports. Joseph Micheletti, a deputy attorney general for New Jersey, told the newspaper he believes the case "should give an opening to the people who really need it."
Not surprisingly, spokesmen for the state health plan administrators at Horizon, and for the state Treasury Department, made two points to the Star-Ledger:
1. Autism services are expensive and raise everyone's health insurance premiums.
2. The state believes the case will have narrow impact, and will lead to case-by-case reviews of autism services claims.
Also noted: In the recent Centers for Disease Control estimates for the prevalence of autism spectrum disorders, New Jersey led the nation at 1 case per 95 children. And New Jersey faces a financial crisis in its state employees health benefits budget, the Star-Ledger reports.
* N.J. Court Rulings: State Workers Health Insurance Covers Autism Services
* Autism Prevalence "More Common" Than Previously Believed, Researchers Say