The idea for the Mental Health and Autism Insurance Project came about when parents came together and realized that their health plans were providing few, if any, services for our children with ASDs. A non-profit was formed in 2009. Our mission is to assist families with children with autism spectrum disorders (and later other mental health conditions) to obtain medically necessary treatments through their health plans, so that they can ultimately reach their full potential.
We do this by fielding questions from the public, offering seminars to the public, educating legislators and regulators on laws that will protect these populations, and providing direct services to assist families with obtaining single case agreements, writing appeals and requesting regulatory intervention. We also help providers and the facilities that serve them by offering pre and ongoing authorizations, appeal writing, billing (for facilities), collecting unpaid claims, and other services, as needed.
Even before her son was diagnosed, Karen Fessel sought to get the most out of her health insurance benefits. Having a Doctorate in Public Health and having worked in a variety of health settings, including Kaiser, she felt that it was important for health insurance to provide medical care that individuals need.
When her son first came to medical attention, Karen was told to take him to the school district for further evaluation. Her son was offered a half hour a week of group speech therapy during his pre-school years. He did not qualify for regional center.
With only a vague diagnosis of expressive and receptive language delay, Karen turned to her health plan to supplement the school district’s meager offering and also to provide occupational and later group social skills therapies. Later, with the diagnosis of Asperger’s, Karen was able to secure regional center support, more extensive educational programs from the school district, and health insurance protection under AB 88, the California Mental Health Parity law.
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Happy Holidays from MHAIP!!
Then end of the year is upon us, it has been an exciting year filled with many surprises. May your holiday season be restful and happy. Enjoy the down time, and be ready to gear up for an active and exiting 2017!!
Open Enrollment Period-Affordable Care Act-Act Now
If you have an insurance plan (through an employer or elsewhere) that does not provide the benefits your family members need, now is the time to purchase a plan on the ACA exchange. Some families with children with autism may have self-insured plans that do not provide needed treatments. If this is your situation, and you live in a blue state (see map below), you may want to purchase a child-only plan on the exchange. If you plan on using more than 10 hours a week of ABA, you may want to purchase a Platinum level plan, as there are no deductibles and the out of pocket annual costs are lower. It is important to know with all the changes on the horizon, that ACA plans will be in effect for the 2017 year.
You are in a "grandfathered health plan" if the plan covered you or your family on March 23, 2010 and has largely remained the same since then, or if your employer has not made significant changes since then. You can find out whether your plan is grandfathered by checking the plan materials or asking your insurer or employer. If you have a grandfathered plan and a child with a significant mental health condition, and you expect that your child may need substantial mental health treatment in the coming year, now is the time to purchase a plan for that child. New plans will all have the protection of the Federal Mental Health Parity and Addiction Equity Act and must provide intermediate forms of treatment, including residential, partial hospital, and intensive outpatient care.
End of year is time for Giving and Reflection
We at MHAIP have had a busy and exciting year. Some of the things that we have done with your generous donations include:
- • Fielding your questions via phone and e-mail from families and providers. We get approximately 2 phone calls and 2 e-mails a day from the general public. We make an effort to return every phone call and e-mail that we get.
- • Working on a new website with updated information --it should be unveiled early in the new year.
- • Giving over 20 presentations in the community and at relevant conferences, training families, providers, family resource workers, physicians and others on how to work with insurance.
- • Building a network of skilled attorneys with whom we consult and hand off challenging cases.
- • Helping families with Medicaid access behavioral health services and speech therapy.
- • Working with attorneys to help make Wilderness programs a covered benefit.
WAYS TO GIVE
OTHER WAYS TO SUPPORT MHAIP
We are excited to be a part of several employer based fundraising programs this year. Through these programs, you can donate to our organization easily through payroll deductions set up with your employer. CA state employees may donate here through the CA state campaign, or with our code 29208. We are also a recognized cause through the corporate employer-matching philanthropic site Benevity (as Mental Health and Autism Insurance Project). We are a write in charity (as Autism Health Insurance Project) through the United Way of the Bay Area.
Wishing you a very Happy and Healthy Holiday Season!
Looking Ahead During Changing Times
As we approach the year's end and a new US presidency, I reflect on all that has transpired since I started The Mental Health & Autism Insurance Project nine long years ago. We started by helping families with children with autism appeal health plan denials. We drove up to Sacramento frequently and spent a lot of time educating our state legislators. We attended public hearings and shared families' stories re the challenges in obtaining treatments. In the early years, before the passage of the CA Autism Mandate, we often walked a tight rope between the health plans and the state regulators.
Fast forward eight years and much has transpired. We continue to work with families with loved ones with autism, we have expanded from CA to a national audience, and we have expanded our scope to help those with other mental health conditions as well. The passage of Affordable Care Act has resulted in huge reforms for MANY people. While many know that you can now purchase a plan without concern for pre-existing conditions, and young adults can stay on their parents' plan to age 26, most people don't know that the passage of the act requires that mental health be included in parity with medical and surgical health. Also, there cannot be treatment limitations that apply only to mental health conditions. The parity law applies to nearly all health plans, including large employer sponsored self-insured plans. Annual and lifetime limits are no longer allowed. In fact, there are now limits on what consumers are supposed to pay out of pocket: Costs for an individual are not supposed to exceed $6850 for plan year 2016 and $7150 for 2017.
These are huge transformations and reflect progress as a society. With the change in the presidential administration comes a huge question mark on what lies ahead for our families with autism and mental health conditions. Those with large employer self-insured plans which are subject to federal law, those on Medicaid, and those that work for government entities will likely feel the impact first. Those who purchase individual plans, those who work for small employers and those in states with poor regulation will also be impacted. We don't yet know how or when it will happen, though the incoming administration recently stated that repealing health care reform will be first on the agenda. We intend to be there and to speak loud and clear on the needs of the families we serve.
Please know that we at the Mental Health and Autism Insurance Project will be looking out for your rights. We will be speaking with state and federal legislators, we will be writing letters, and we ask you to do this, as well. Share your stories, share them far and wide. Speak to the press. Write letters to the editors. Share on social media. Let everyone know how your lives are better for Health Care Reform, Autism Mandates and the Federal Mental Health Parity Act.
We can't do it without your help. This type of work takes time, effort, and money. Please add us to your list of charities. Please remember to donate. We are plugging for you, but we need your support in order to keep these rights that we have all fought so hard for. Remember, DON'T TAKE NO FOR AN ANSWER!! Now more than ever! Please give.
Other Ways To Give
Federal employees can donate to MHAIP by visiting www.norcalcfc.org and search for "Autism Health Insurance Project" or with the 5-digit Code 88784. CA state employees may donate here through the CA state campaign, or with our code 29208. If your company uses Benevity, we are listed as Mental Health and Autism Insurance Project. We are a write in charity (as Autism Health Insurance Project) through the United Way of the Bay Area.
When you shop on Smile.Amazon.com, you can select our organization to receive a small percentage of the purchase price by using this link. All donations made to MHAIP are tax-deductible. We appreciate your support!
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