The Law Offices of Sheryl Gandel Mazur
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Will Obamacare include benefits for autistic children?

Behavioral health services for those diagnosed with autism spectrum disorder were originally intended to be included as part of the essential benefits package in the Patient Protection and Affordable Care Act, according to a statement made by the Secretary of the U.S. Health and Human Services earlier this year.

However, although the Supreme Court recently upheld the Act's individual mandate provision requiring all Americans to obtain health insurance, the coverage for children with autism under the Act remains unclear. Specifically, grandfathered insurance plans may not be subject to the Act's mandates under a loophole.

Assistance may be available through various other sources, however, including insurance plans and federal benefits programs like Supplemental Security Income. For example, in a case decided 5 years ago, the state's highest court required an insurer to pay for intensive therapy for a child with autism. In 2010, a state law also mandated certain autism coverage for all state-run and state-licensed insurers.

Autism is a developmental disability that impairs a child's ability to communicate, learn, and form social relationships. According to a recent count, the number of New Jersey's public school children diagnosed with autism tripled from 2002 to 2011. The state is reported to have the second-highest autism rate in the nation, with 1 in 49 children diagnosed with the neurological disorder.

Autism is included on the Listing of Impairments maintained by the Social Security Administration. For that reason, SSI coverage may be available to some children with autism. SSI for children is a financial program for families with low incomes who have a child under the age of 18 with a qualifying disability under the SSA.

To apply for benefits for your autistic child, the SSA may require certain evidentiary showings of qualitative deficits in developmental areas such as reciprocal social interaction, verbal and nonverbal communication, and imaginative activity. If you have questions about whether your autistic child may qualify for SSI, an attorney can be your best resource.

Source:, "PPACA Patient Protection and Affordable Care Act is your ASD child covered?" Elsa Petersen, July 15, 2012

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