Autism Spectrum Disorder (ASD) diagnoses seem to be on the rise. Why is this? We investigate what current data reveals about autism rates, the disparities that exist, and why the statistics don’t necessarily tell the whole story. 

If There’s No Autism Epidemic, Why Are the Autism Statistics Climbing? 

Having just emerged from the throes of the COVID pandemic, it’s fair to say that we have become acutely aware of the many medical conditions that afflict us as a society. More recently, though, we are witness to another perceived crisis, the autism epidemic.  

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that affects a person’s communication, social interaction, and behavior. It’s called a “spectrum” disorder because it affects people in different ways and to varying degrees.  

Some people with ASD may have difficulty with social cues or communicating their wants and needs, while others may struggle with repetitive behaviors or intense interests in specific topics. ASD is typically diagnosed in childhood and can affect a person throughout their life. 

According to multiple reports from the CDC and other medical journals, autism spectrum disorder statistics show sharp increases in the last few years. Yet experts say there is no need to be alarmed and that there is no epidemic. Let’s look at the data and investigate why the numbers continue to rise, and why experts remain calm. 

What the data says

According to several studies reported by the Center for Disease Control (CDC) as well as medical journals like Pediatrics and Autism Research, autism facts and statistics show a marked rise in the number of ASD diagnoses in children between the ages of 4 and 8, both in the USA and the rest of the world. 

Autism in the USA

A study published in the journal Pediatrics found that the rate of autism among children in the New York and New Jersey metropolitan areas tripled between 2000 and 2016.  

In the CDC’s 2021 follow-up report on autism in the USA, statistics showed similar increases to what was observed in New York and New Jersey. In 2016, one in 54 children had been diagnosed with autism by age 8, compared to 1 in 150 in 2000. 

Another study announced by the CDC in 2023 showed that the number had jumped significantly to 1 in every 36 children. This was up from 1 in 44 in 2021. 

Autism across the world 

A recent study published in the journal Autism Research revealed that the global prevalence of ASD has increased to around 100 in 10,000 (or 1 in 100) children. This is a significant rise from the 2012 global prevalence report, which estimated that 62 in 10,000 children had ASD. 

What are the reasons for the rise in numbers? 

So what do these statistics on autism really mean? And why don’t the experts seem to be worried? The answer, it appears, is layered. There are a number of factors that contributed to autism seeing an increase in statistics, but most of them point to better reporting rather than an increase in the actual number of cases. 

Better diagnoses

According to the team who conducted the New York and New Jersey study, the increase in autism spectrum disorder diagnosis is mainly due to the advancements in diagnostic capabilities and a greater understanding and awareness of the disorder. This is especially prevalent in diagnoses of ASD in children without intellectual disabilities.  

The study showed the percentage of 8-year-olds diagnosed with autism in New York and New Jersey without intellectual disabilities had increased more rapidly than those with intellectual disabilities. From 2000 to 2016, the percentage of those without intellectual disabilities increased five times, while the percentage of those with intellectual disabilities increased only twice. 

This is primarily attributed to advancements in diagnostic techniques rather than an increase in cases. 

The increase in autism prevalence in other parts of the world is also attributed to improvements in public awareness and healthcare systems that respond to autism. 

Now, children are diagnosed at an earlier stage, and regions such as Africa and the Middle East, which were previously underrepresented, have made progress in measuring autism prevalence. 

Racial and gender disparities

The New York and New Jersey study also showed that although the gap has decreased, there are still racial disparities in autism diagnoses. In the past, Black and Hispanic children were diagnosed with autism less frequently than white children.  

The recent analysis revealed that Black children without intellectual disabilities were 30% less likely to be diagnosed with autism than white children. 

According to a neurodiversity scholar at the College of William & Mary, too many marginalized individuals who belong to racial or gender minority groups may not receive an autism diagnosis due to less effective screening tools.  

As diagnostic tools and expertise continue to improve, more individuals from these groups may receive a diagnosis, leading to an increase in autism diagnoses overall. 

Autism in women and girls

Studies have shown that autism is often underdiagnosed in girls and women, as well as in people with less visible symptoms. The latest CDC report shows a 4-to-1 ratio of male-to-female diagnoses, but some scholars are not completely convinced that this accurately reflects the reality on the ground. 

In other research, some academics found that there are often more autistic female students than male students in college groups. And as one social worker has shown, many women are diagnosed with autism later in life, often after they’ve become mothers or grandmothers. This suggests that there are still many girls and women who are going undiagnosed today. 

As these diagnoses increase, so will the overall number of cases. 

Genetics

According to one analysis, around 83% of the risk of developing autism comes from inherited genetic factors. The study pointed out that autism is likely influenced by 2,000 to 3,000 genes, but only about 100 of them are consistently linked to the disorder. 

It was also shown that older parents are more likely to have autistic children, and recent trends show that more people are waiting longer to have children. This is flagged as another possible contributor to the increase in ASD prevalence. 

Lighthouse Autism Center makes life better

Given the increased awareness of ASD prevalence in the USA, it is important to seek out support systems and resources to help families with autistic children. The vast repository of autism resources and LAC’s innovative and groundbreaking Lighthouse Fusion ABA Therapy provide autistic children with the ideal path to holistic well-being. 

Applied Behavior Analysis (ABA) therapy is a necessary medical expense to help our autistic children thrive. But do our health insurance providers cover ABA therapy? Let’s find out how to check your coverage, how your coverage works, why you might not be covered, and how to get the best out of it.

How Do I Know if My Insurance Covers Aba Therapy?

Autism spectrum disorder (ASD) is a well-known and understood condition, yet we often don’t know whether our health insurance providers cover the treatments our autistic children need to thrive in the world. This is especially true of insurance coverage for ABA therapy. 

Applied Behavior Analysis (ABA) therapy is a treatment that helps people with autism spectrum disorder and other developmental disabilities improve their behavior and communication skills using behavioral principles. 

ABA typically involves working with a licensed ABA therapist, who designs and implements a personalized treatment plan for your child. The frequency and duration of therapy sessions may vary depending on their specific needs. Obviously, these treatments and sessions cost money. 

So does your insurance actually cover ABA therapy? To avoid any nasty surprises when we submit claims against our health insurance policy for ABA therapy, it is important to know the answer to this question beforehand. You’ll need to know your coverage works, why you might not be covered, and how to get the best out of your coverage. 

How does ABA coverage work?

Health insurance coverage for autism, and more specifically, ABA therapy insurance, is dependent on a few things. Firstly, you need to understand the type of health insurance plan you have.

In the past, there were very few formal regulations governing ABA therapy for autism and insurance coverage. More recently, however, state and federal governments introduced laws to ensure more uniform coverage across plans and divided the plans into two specific types: self-funded plans and fully insured plans.

Self-funded

These plans are regulated by federal laws rather than state laws. Under this plan, your employer decides what is covered and what isn’t. These plans are not mandated to cover ABA therapy, but as a result of federal mental health parity law requirements, ABA coverage on self-funded plans is increasing.

Fully insured

These are the most common plans offered by employers and must comply with state laws regarding coverage of ABA benefits. Under this type of plan, the insurance company decides what is covered and what is not covered, subject to state regulations. All 50 states mandate that these plans cover ABA. 

The following list will give you an idea of how fully insured plan regulations differ from state to state.

Arkansas

ABA therapy is covered if provided by a supervised, Board Certified Behavior Analyst.

California

A plan covering physical treatments must also cover mental health services. ABA is considered a covered treatment.

Delaware

ABA therapy and necessary items or equipment needed for treatment are covered.

Florida

ABA therapy is covered under state-regulated plans. If you were diagnosed with a developmental disability at age eight or younger, you are eligible for coverage. If you’re over 18, you will still receive coverage as long as you’re still in high school. Coverage for autism in Florida is capped at $36,000 per annum, with a lifetime limit of $200,000.

Georgia

ABA is not explicitly covered in Georgia.

Indiana

In Indiana, ABA is not explicitly covered, but treatment for autism and related disorders can’t be subject to limits or deductibles.

Massachusetts

ABA therapy is covered under MassHealth Standard, CommonHealth, and Family Assistance. There are age limits, but private, fully funded options are available too.

Montana

ABA is not explicitly mentioned, but treatment for autism spectrum disorder can be capped at $50,000 per year for children under eight.

New Hampshire

Coverage for autism is covered under state-regulated plans. Coverage is capped at $36,000 per year for individuals aged 0 to 12 and $27,000 per year for those aged 12 to 21.

It is crucial, however, to check your plan properly. While all 50 states include ABA therapy and autism treatments in their base requirement, some may not enforce full coverage as part of the state regulation. 

How to find out if you’re covered

The first step is to establish which type of plan you’re on. Call your employer’s health insurance representative (usually the HR department) to find out exactly which plan you are on. Once you know if you’re on a self-funded or fully insured plan, you need to find out if you have ABA insurance coverage.

When talking to your health insurance representative about insurance for ABA therapy, you need to ask the following questions: 

1. Does my current plan cover the screening, diagnosis, and treatment of autism spectrum disorder?
2. Does the plan cover ABA therapy?
3. Can I obtain a copy of the Summary Plan Description (SPD) to review coverage details and specific exclusions in writing? It’s crucial to document coverage in writing for future reference.

Choosing a new or different plan

If your current plan does not offer sufficient cover, consider changing your plan. Most employers offer multiple plans, while some even offer both self-funded and fully insured options.

If you have the option of a fully insured plan, you should inquire about the state that regulates the plan, which is typically the state where the company is headquartered rather than your place of residence. 

You should also ask whether it is a small group or large group plan. You can then check whether the state that regulates the fully insured plan mandates coverage in the type of plan offered by your company.

Child-only insurance

Young children with autism often require up to 40 hours of ABA therapy per week, making a child-only insurance plan a wise financial decision. This will allow your child to receive the recommended amount of therapy necessary to reach their full potential.

You can go through the Healthcare Marketplace to obtain a child-only insurance plan. The ABA benefit is included in the “Essential Health Benefits” package, which is mandatory for all Marketplace plans in Texas and Colorado.

It’s important to note that Healthcare Marketplace plans can only be purchased during designated Open Enrollment periods.

How to get the most out of your coverage

Once you have selected a plan that suits your needs and budget, you should spend time interrogating the details of ABA therapy for autism and the insurance coverage per benefit. Knowing how your plan works will empower you to extract as much value as possible without incurring additional costs. Here are some benefits and rules you should keep in mind when using your insurance. 

Deductibles

The deductible is the amount you need to pay before your insurance starts contributing. You’ll have to pay this every year.

Copayment or coinsurance

You’ll either have a copay or a coinsurance. A copay is a fixed amount you pay per visit, including for ABA therapy. Coinsurance is a percentage of the total charges you’re responsible for paying after you’ve paid the deductible.

Out-of-pocket maximum

This is the highest amount you’ll have to pay in a year. Once you reach it, you won’t have to pay any other out-of-pocket expenses for ABA therapy for the remainder of the year. Like your deductible, the out-of-pocket maximum resets each year.

Documentation requirements

Experts recommend that a good insurance plan requires ongoing documentation of your child’s progress. Your child’s Registered Behavior Technician (RBT) will need to submit documentation to show that the treatment is effective. A Board Certified Behavior Analyst (BCBA) will review the progress reports. Although you are not responsible for creating these reports, they are a crucial component of ABA therapy.

In-network practitioners

Use therapists and Board Certified Behavior Analysts (BCBAs) who are in-network with your insurance provider.

Pre-authorizations

Make sure to submit all necessary paperwork before beginning ABA therapy sessions to be certain the costs have been authorized. Failing to do so could leave you responsible for paying the entire bill. A formal diagnosis of autism spectrum disorder and a comprehensive behavior assessment are generally required for ABA therapy.

Lighthouse Autism Center covers your autism treatment needs

Lighthouse Autism Center meets the requirements of most health insurance plans. Through diligent use of your insurance, you can take full advantage of our Lighthouse Fusion ABA Therapy and the many other autism resources available from the Lighthouse Autism Center.