The case is called Jacob Micheletti v. State Health Benefits Commission, and the court ruled the state had to pay for therapies including sessions of Applied Behavior Analysis (ABA), occupational therapy and speech therapy for five-year-old Jacob. NPR interviewed members of the Micheletti family for the story. I will post a link to the story after NPR makes it available; you can also search for it on NPR.org.
UPDATE: The NPR story by Larry Abramson is a must-read (or must-hear) piece for parents of kids with autism, especially those who are interested in the health insurance debate and the characterization of Applied Behavior Analysis (ABA) services as experimental by the health insurance industry. In addition to recounting the Micheletti family's successful quest for coverage in the New Jersey courts, Abramson sheds important light on the issues involved in paying for it, and how insurers resistant to cover these services seek to cast doubt on the effectiveness of ABA.
To read Abramson's story and find a link to hear it (7 minutes and 45 seconds long) go here.
Here's a key passage:
Many insurance companies say they will not cover ABA because they view it as experimental and unproven. The New Jersey State Health Benefits Commission declined to speak to NPR. NPR contacted a number of private insurance companies, such as CIGNA and AETNA. Those companies declined to be interviewed, but they did send regulations that state that they won't cover therapies considered experimental — including ABA.
Pamela Greenberg of the Association for Behavioral Health and Wellness says there just is not enough data on the effectiveness of ABA therapy.
"Yes, there are examples of where ABA has been very effective. And there are other examples of situations where it has been very harmful," Greenberg says. "Coverage decisions need to be made based on the best possible medical evidence and not just on the experience of a few cases."
The Michelettis' victory comes as parents of autistic children across the country are pushing for better coverage of this disorder. But better coverage for some families may mean higher premiums for everyone. That presents a dilemma for insurance companies, according to Mohit Ghose of America's Health Insurance Plans.
"The question then becomes: do you provide that through the healthcare setting, or do you provide that through the educational setting as many states have traditionally done?" Ghose says.
To read more about the case, including links to legal documents, please see:
* New Jersey Supreme Court Upholds Autism Services for Child of State Worker
South Carolina Legislature Overrides Veto to Pass Autism Insurance Law
Report on Texas autism insurance legislation and map of states with coverage