ABA coverage available in 2020

PIERRE, S.D. – Governor Kristi Noem, in conjunction with Avera and Sanford Health, announced big news for families who lost coverage for their children's autism therapy.

On Friday, the governor's office said health insurance coverage options that include Applied Behavioral Analysis (ABA) therapy will be available in the South Dakota insurance market for 2020.

“As governor and as a mom, I understand how important it is to get kids the kind of care they need,” Noem said. “After talking with parents of kids with autism and assessing the coverage options available, we recognized the need for an alternative option. I’m thrilled to announce Avera and Sanford have found a way to provide added coverage options for kids and families with autism.”

Earlier this year, a bill that would have mandated South Dakota health insurers to include autism and spectrum disorders in their coverage was killed in committee.

South Dakota obtained approval under the federal review process to update the Essential Health Benefits benchmark plan. In 2021, all Affordable Care Act (ACA) individual and small group plans will be required to include coverage for ABA therapy for the treatment of Autism Spectrum Disorder. Federal deadlines and plan filing requirements set the implementation date for plan year 2021.

In a statement, Noem, Avera Health Plans and Sanford Health Plan stated they recognized a delay in implementing coverage for ABA therapy could have a significant impact on the children the therapy is designed to help.

The result is a short-term solution where both carriers will offer at least one individual health insurance plan option for 2020. The plan(s) offered will include coverage for ABA therapy at the benchmark level approved by the Centers for Medicare and Medicaid earlier this year. They will be offered directly through each carrier outside of the ACA Marketplace, meaning the plans will not be available on the exchange.

Open enrollment for plans offered in 2020 will begin on Nov. 1, with coverage effective Jan. 1, 2020.