Legislation has been pre-filed for the upcoming legislative session that would expand insurance coverage for developmentally disabled individuals.

Missouri child with a developmental disability

Missouri lawmakers passed a law in 2010 that provided coverage for those inside the Autism spectrum. The bill submitted for lawmakers to consider in 2019 covers the cost of therapy for those with conditions such as Down syndrome and cerebral palsy.

Currently, therapy for developmental disabilities can cost up to $100 an hour. Insurance plans generally cap coverage at 20 visits, which is unrealistic for the families of most recipients who require three-to-four different sessions a week to assure adequate treatment. Robyn Schelp, the president of Missouri Disabilities Empowerment (MoDE), says the costs add up for families with developmentally disabled kids.

“You’re easily talking $15,000 a year on top of what we already pay for regular insurance,” says Schelp.

Lara Wakefield is a speech-language pathologist who is also a member of MoDE. She says families with developmentally disabled children not only have to pay out of pocket but will often also have a stay at home parent to care for the child.

“They lose that second income to be able to pay for that,” says Wakefield. “So, many families are basically going into debt to try to get the therapy for their kids that they need.”

Medicaid covers low-income developmentally disabled youth in Missouri. And since the Affordable Care Act’s provisions came into force in 2014, speech therapy has been covered along with 20 visits for occupational therapy and physical therapy combined. MoDE’s Shelp notes the 2010 Missouri law that covers individuals on the Autism spectrum only includes 50 percent of all individuals with developmental disabilities.

“So, we want to just see the other 50 percent of kids with developmental disabilities getting the same coverage,” Shelp says.

Two similar bills pre-filed in the legislature would piggyback on the Autism law to cover developmentally disabled individuals through age 18.

One was submitted by Republican Senator Denny Hoskins of Warrensburg while the other was filed by Republican Representative Chuck Basye of Rocheport.

State Rep. Chuck Basye speaks on the Missouri House floor in February 2018 (photo courtesy of Tim Bommel at House Communications)

Basye has filed largely the same bill three years in a row. The legislation has failed to advance beyond the committee level for the past two sessions after opposition from the healthcare industry which claims consumer costs would rise.

Missouri Insurance Coalition, Blue Cross Blue Shield of Kansas City, America’s Health Insurance Plans, and Anthem testified against his measure in committee this year while Gateway Association for Behavior Analysis, Missouri Association for Behavior Analysis and the Down Syndrome Association of Greater St Louis spoke in favor of it.

Despite passing out of a committee on insurance policy and a panel on legislative oversight unanimously, Basye’s bill never reached the House floor.

The retired air traffic controller says his measure didn’t advance out of committee until late in the session when most legislation that hasn’t reached the House or Senate floor has little chance of crossing the finish line.

He admits the insurance industry is a powerful lobby group in Jefferson City but is hopeful it’ll work with him in the upcoming session.

“They admitted in a private meeting that they should have done this back in 2010, (that) they should have covered all the disabilities, but the focus was on autism then,” says Basye.

MoDE’s Schelp says her organization ran numbers based on the cost of the Autism coverage and estimates insurance companies would only see a small increase to cover all developmental disabilities. 

“Insurance would pay $0.51 extra for each plan they have per month,” says Shelp.

The new legislation would prohibit health carriers from limiting coverage or denying reimbursement for treatment of symptoms and behaviors for individuals with physical or developmental disabilities.  Proponents say children with developmental disabilities don’t have enough access to therapeutic services and stress that getting the right kinds of therapy to them early is important for their future success.

MoDE’s Wakefield says early treatment can pay big dividends for the developmentally disabled individual and for the public as a whole.

“They can progress and become more independent by the time they’re in that 18-to-21 range, so that they actually get jobs, be employable and not be on as much public assistance lifelong,” Wakefield says.

According to Boone County Family Resources, there are about 64,000 Missouri children under the age of 18 with a disability.  The organization says 28,068 of them have private health insurance coverage, while 37,405 receive Medicaid, which is public health coverage. Another 3,147 have no health insurance coverage.

The Missouri Legislative session starts January 9.

Copyright © 2018 · Missourinet