Sanford, Avera to Offer 2020 ABA Coverage Aimed at Helping SD Families with Autism

SIOUX FALLS, S.D.-A gap in autism therapy insurance coverage has left some parents concerned in South Dakota, but now there may be new hope for these families. Governor Kristi Noem announced that Avera and Sanford plan to offer ABA coverage in 2020. ABA therapy is for kids with autism. It focuses on improving specific skills like communication.

Each week, three-year-old R.J. goes to ABA therapy. His mom Lindsey Janklow says it’s played an important role in his development. 

“He’s non-verbal, he self harms and the difference we’ve seen over a year is unbelievable,” aid Janklow. 

At the beginning of this year, Janklow, along with other families who have small group or individual insurance plans lost coverage for ABA therapy. And would have all had to wait until 2021 for insurance coverage. So Avera health plans and Sanford health plan are offering ABA coverage in 2020 to fill the gap.

“We agreed that we would put the ABA therapy on one of our individual plans that’s offered off the exchange for our members,” said Kate Parker, Director of Consumer and Government products for Avera Health Plans. 

“Both Sanford and Avera covering this benefit helps equalize across the companies and we know how beneficial it is for families and we understand that it’s important to continue this Janklow says this coverage will help some families. 

“It’s a step in the right direction. I’m happy that some families will have the option to pay for premium outside the marketplace,” said Janklow.

However, it’s not an option for everyone. She has blue cross blue shield under her employer and ABA is not covered. She currently pays out of pocket for the therapy. If she wants ABA coverage she would have to switch over to the specific Sanford or Avera individual health plan that’s being covered for 2020. However, she’s choosing to wait until ABA therapy is covered by all small group insurance plans in 2021. 

For small business owners like Darcy Weber, it’s too expensive. 

“I’m excited that they are offering something for families and I’m thankful for it, but also at the same time our family can’t afford it because we use the exchange in order to get the tax bracket,” said Weber. 

So her son Easton had to stop ABA therapy.  

“It’s been a devastation since we haven’t had the ABA therapy because he’s having a lot more behavioral issues, a lot more aggression,” said Weber. 

Both moms say offering some options in 2020 is a start, but they believe there needs to be an affordable option that allows all children with autism to be covered.

According to a press release sent out by Governor Noem, “The plan(s) offered will include coverage for ABA therapy at the benchmark level approved by the Centers for Medicare and Medicaid earlier this year. They will be offered directly through each carrier outside of the ACA Marketplace, meaning the plans will not be available on the exchange. ABA therapy services will be subject to the individual carrier’s plan management programs, medical necessity reviews, and pre-authorization requirements.”

Enrollment for the individual health policies starts November 1 and runs through December 15. Coverage goes into effect January 1, 2020. For more information on Avera or Sanford’s 2020 individual health plans click here: https://www.averahealthplans.com/insurance/ or https://www.sanfordhealthplan.org/

 

 

     

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