Despite Insurance Compromise, Families Struggle to Keep Children with Autism in ABA Therapy

Nov 7, 2019

Credit SDPB

Applied Behavior Analysis, or ABA therapy, is one of the most effective treatments for children with autism. But South Dakota families lost health insurance coverage for the expensive therapy earlier this year.

The state since added ABA Therapy to its benchmark plan under the Affordable Care Act for 2021, but some families are still without coverage despite a compromise between Sanford and Avera Health Plans. 

Sanford and Avera Health Plans are offering ABA coverage options directly through their websites to bridge the 2020 coverage gap before the new benchmark plan takes effect. However, the option came too late to be posted on the healthcare.gov exchange.

Darcy Weber runs her own ABA therapy business in Watertown, and her fiancé is a farmer. She says it’s difficult for two small business owners to find a plan that’s affordable to keep her son Easton in ABA therapy.

“We use the exchange to help us with the tax bracket for him to get insurance that’s affordable for our family. Because we make too much to qualify for Medicaid, but not enough for us to afford the 500-dollar-a-month plans, you know?”

Weber says only about half of families she knows are able to afford the 2020 options through Sanford or Avera.

Lindsey Janklow of Sioux Falls is insured through her employer’s plan with Blue Cross Blue Shield, who did not offer a 2020 option. She’s paying out of pocket to keep her son RJ in therapy.

“We have about, I don’t know, $60,000 probably racked up in bills right now. And right now we’re paying on a payment plan, so. It’s kind of a nightmare, but your brain only develops once, and so it’s kind of a critical window for him right now to get the therapy that he needs.”

Janklow notes the 2021 benchmark puts limits on ABA coverage based on age and hours-per-week. She says those limits still won’t cover her son’s therapy costs entirely.

The 2020 plans through Sanford and Avera that include ABA therapy are available for open enrollment until December 15th. 

Regional Health supports Education and Healthcare reporting on SDPB.