Federal insurance providers not required to provide autistic children specialized treatment

Autistic children of federal workers in 22 states begin receiving insurance coverage this month for a key behavioral treatment, under a decision by the Office of Personnel Management.

Maryland, home to the third-largest population of federal workers in the nation, is not one of them.


"These families desperately need the best coverage for their kids," said Stuart Spielman, senior policy adviser and counsel for Autism Speaks. He said the advocacy group would petition the OPM to expand its coverage as quickly as possible.

"I am always hopeful that we are going to see positive changes," he said. "I can tell you we will be working to make sure more children, rather than fewer, will be covered."


Advocates say the treatment, called applied behavior analysis, or ABA, is essential to helping autistic children reach their fullest potential. But under the Federal Employees Health Benefits Program, it had been considered an educational, not medical, intervention.

The OPM has decided to allow, rather than require, coverage for ABA. Maryland is one of 28 states and the District of Columbia in which no insurance carrier for federal workers is providing coverage.

For autistic children of federal workers in Maryland and other such states, OPM Director John Berry said, the Federal Employee Health Benefits Program covers speech, occupational and physical therapy, mental health treatment and medications.

"This decision on ABA coverage offers an opportunity for the provider base to grow and ABA coverage to expand," Berry said in a statement. "Knowing the impact this therapy can have on federal families, we are committed to continue monitoring and studying ABA on an annual basis."

But Jacque Simon, policy director at the American Federation of Government Employees, said the mix of therapies and medication is not a substitute for applied behavior analysis. Simon said the union has fought for decades for coverage.

"It's long been recognized as the most effective treatment," she said. "It's been absolutely horrible on the part of OPM to delay coverage for this long. It's really a half-measure, but it's better than nothing."

Rebecca Landa, director of the Kennedy Krieger Institute's Center for Autism and Related Disorders, described applied behavior analysis as a set of principles that guide intervention for children with autism on areas as diverse as social interaction, tooth brushing and math lessons. The treatment provides clear instructions, cues, prompts and feedback tailored to the individual child's ability level.

Landa said intervention at a young age —when the brain is most malleable — is important so the child's social and educational development is not limited.


Because the treatment is expensive, paying for it out of pocket is difficult for many families.

"We have the technology to help individuals with autism learn more effectively, which really reduces the costs to society," Landa said. "I do think it's time for insurance companies to examine carefully their decision about providing these kinds of interventions for individuals with autism."

The Centers for Disease Control and Prevention reports that autism affects about one in 88 children.

The OPM announced in April that it would allow, but not require, carriers to provide the coverage for families of federal workers. The decision was based on clinical research and evidence from the state-level coverage that is administered by health professionals, spokeswoman BrittneyManchester said.


Lacking coverage

Maryland is one of 28 states in which insurance carriers do not cover a key autism treatment for children of federal workers. The Office of Personnel Management has declined to demand the coverage. States in which no carrier is offering the coverage include:



The District of Columbia




New Jersey

North Carolina



Rhode Island


West Virginia

Source: Office of Personnel Management