In 2011, California parent advocates were able to get the nation’s most progressive Autism Insurance Mandate bill signed into law. The law says that all California-governed health insurance companies must pay for diagnosis and evidenced-based treatment for autism NO MATTER the person’s age or IQ. Typically families access ABA (sometimes call BHT or Behavioral Health Treatment, speech and occupational therapy services. While the new law was a big success, it still can be challenging to navigate through your health insurance for autism services. Two people could have Blue Cross Blue Shield, but have different benefits depending on the company they work for. The easiest place to start is to call the number on the back of your medical health insurance card and ask about autism benefits. The help desk should be able to tell you what services you qualify for, and what your co-pays and deductibles are for using the services.
Medi-Cal families: As of July 1, 2018, families no longer have to have a Comprehensive Diagnostic Evaluation (CDE) to start autism treatment. A CDE is considered best practice, but the waiting times can be very long (6 months or more). You can get on the list for the CDE, but ask your primary care provider to write a referral to start ABA, speech, and occupational therapy (whichever is medically necessary).
Note: California Insurance companies have an obligation under the California Timely Access Law that non-urgent appointments with specialists will have to be set within 15 business days. If this is not being done, you may file a complaint or grievance with your insurance company. If this does not resolve the issue, you may file a complaint with the California Department of Managed Health Care.