Autism bill removes age cap for private insurance coverage

Published: May. 28, 2019 at 11:57 AM EDT
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RICHMOND, Va. (WWBT) - A major change is coming for children with autism growing up in Virginia.

On Tuesday, Gov. Ralph Northam officially signed a bill into law that will help tens of thousands of families by expanding the insurance coverage children with autism receive.

That includes children like 4-year-old Jacob Korte. He happens to love lights, but to his parents, he is a light.

“We’re very very proud of Jacob," said mother Molly Korte. "He is a good kid.”

Jacob also has autism, which means he sees things differently and sometimes does things differently.

And he sometimes faces challenges others don’t. One thing helping with those challenges is intensive therapy.

“They work on essential skills such as toilet training, interaction, how to have conversations with people, how to respond to his own name, these are things you just don’t think about unless you have a child who is on the spectrum,” said Korte.

The therapy is expensive. Many private insurance companies consider autism a condition that can’t be remedied, so the insurance providers have been able to opt out of ongoing coverage of the therapy.

That makes the life-changing therapy largely unattainable for many Virginia families.

“We wouldn’t be able to live in a house,” said Korte. “On average, behavioral therapy is about $200 per hour. And most, I know for Jacob, he was recommended 20 hours a week.”

For many families that’s been a reality - no coverage.

Lobbyists have fought for coverage for years, slowly raising the cap to 10 years old. That means kids 11 and older didn’t necessarily get coverage for the same services that may have been covered the day before.

“When they wake up at age 10, it doesn’t mean that the autism went away,” said Korte. “It’s always a part of them.”

The Kortes are breathing a sigh of relief knowing Jacob is going to get the chance to get help at an affordable rate, long beyond his 10th birthday.

“It gives them a better chance to be a productive individual,” said Korte, speaking to the benefit of the therapy.

“That’s essentially what we want as parents for our kids," she said. "... The opportunity to be a productive individual and that’s what this opportunity means for us.”

The legislation is a light at the end of what has been a very long tunnel for those who have fought for this coverage. And for tens of thousands of Virginia families and their children.

The ceremonial bill signing was held at the Bell Tower on Tuesday.

The new law will provide coverage for medically necessary care for individuals with autism of all ages under state-regulated, large group plans starting in January 2020.

NBC12 recently hosted a Digital Dialogue during Autism Awareness month. You can re-watch it below and share on Facebook:

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