DCI News

Jefferson City, Mo. – The sixth annual autism report from the Missouri Department of Insurance shows that more than 3,000 individuals were treated for autism-related conditions in 2016, receiving nearly 85,000 autism treatments of which 47,434 were applied behavioral analysis (ABA) sessions covered under Missouri’s mandate. 

Using data supplied by health insurance companies, the report says, in terms of dollars, insurance claims for autism-related treatments totaled $11.3 million in 2016.  Of that amount $5.8 million was directed to ABA services.  However, in terms of the relation of autism treatments to overall health claims, autism treatments represented just over two–tenths of one percent of overall health claims costs in 2016.  Claims for ABA sessions represented just 0.12 percent of total incurred claims for 2016.  

“The data continues to show the autism mandate is not having any appreciable impact on health insurance premiums in Missouri,” said John F. Rehagen, Acting Director of the Missouri Insurance Department. “However, we continue to see the law have significant impact in terms of real growth in the number of evidence-based treatments being accessed by Missouri children and in the growing number of autism service providers in our state.  This law is working as intended."

The number of licensed professionals providing ABA treatment continues to grow, with over 358 Applied Behavior Analyst providers currently licensed in Missouri.  This number does not include licensed psychologists, line therapists who may also provide ABA services, or other medical professionals who provide other related therapies.  The 2017 report identifies there was a 30 percent increase in ABA providers in 2016, with four Missouri counties seeing new ABA providers in 2016.  

Other noteworthy findings from the department's report:

• Across all market segments, the average per member, per month (PMPM) cost in 2016 for all autism-related claims was $0.62 and was just $0.32 for ABA treatments.
• ABA treatments comprised just over one half of all autism treatments provided in 2016.
• The average annual ABA costs for those 18 and under equaled just under $2,300 per year, or only 5.2 percent of the statutory maximum required coverage.  This annual cap was originally set at $40,000 per year for each covered insured, subject to medical need. 
• Across all market segments, 98.4% of Missourians were covered by a health insurance plan that provided coverage for autism treatments.
• In the individual health insurance market, 93% of Missourians have autism coverage included.  This is a dramatic increase from 2013, when less than 1/3 of individual health insurance policies had autism coverage included. As noted above, the law originally required health insurance companies to cover $40,000 for applied behavior analysis therapy per policyholder, to be adjusted yearly by the director of the Department of Insurance using the Consumer Price Index. The maximum benefit for this year is $43,826, subject to medical need.

Missouri's landmark autism law was passed by the Missouri General Assembly on a bipartisan basis and signed by the Governor in 2010.  

The Department of Insurance has extensive resources for families and health care providers on its website. Consumers and providers with complaints or questions are encouraged to call the department's Insurance Consumer Hotline at 800-726-7390 or file a complaint at insurance.mo.gov.