Many children with autism will have to wait longer for treatment coverage in South Dakota

Investigates

We have an important follow up to a KELOLAND News investigation involving the health of children in the state.  

In February we revealed that many children with autism were losing the therapy that helped them the most.  A loophole in state law meant their insurance companies were not required to cover what’s known as Applied Behavior Analysis, which has been proven to help children with autism. 

Now the law in South Dakota will be changing, but not enough, and not soon enough according to some parents. A number of KELOLAND mothers have been fighting for their children with autism, to get health care coverage of ABA therapy. 

South Dakota law already requires large insurance pools cover the therapy, but not for those who are part of small groups or individual policies. Now a new plan approved by the feds for South Dakota will require all private policies cover it beginning in 2021, but with limits in place. The question KELOLAND investigates is looking into Wednesday night is whether those restrictions are legal.  

Lindsey Janklow was among the group of parents who asked South Dakota lawmakers to close the loophole that allowed insurance companies to stop paying for their children’s ABA therapy on individual or small-group plans. The legislative committee killed the bill, saying it would cost too much.

“I guess I just feel like no one was listening to us,” Janklow said. 

Now Janklow is sinking deep into debt to get her 2-and-a-half-year-old son,  RJ,  the help he needs. 

“I’m still sending him to therapy because he needs it. There is no other option. And I obviously can’t afford $35,000 in bills from February to now. But when it is the difference between him being able to speak and there’s just no choice. I have to send him to therapy,” Janklow said. 

South Dakota recently received federal approval to close the loophole for private insurers when it comes to paying for ABA therapy. But that won’t go into effect until 2021. 

“I think it’s a step in the right direction; but the therapy is needed now, it’s urgent . Our kids are going to fall through gaps and they need therapy now. We can’t wait until 2021,” Janklow said. 

“This was the soonest a benchmark change could be implemented. There’s no ability to change the benchmark for next year, for 2020, ”  Jill Kruger, Deputy Director, SD Division of Insurance said.

However, other surrounding states made more immediate changes to comply with federal law. Insurance Divisions in North Dakota, Idaho and most recently Wyoming, all issued bulletins, saying the autism therapy must be covered under the federal Mental Health Parity Act and that a “health plan cannot impose limitations on a numerical basis, such as visit limits.”

South Dakota’s new coverage requirement for insurers limits the therapy for autism by hours and age. 

Jill Kruger, Deputy Director, SD Division of Insurance: We submitted all the information and the documentation and our actual study to CMS, the feds to review this and they marked it approved with the benefit as they laid out.

Kennecke: So you’re saying the feds approved it, so it must meet requirements of the law. 

Kruger: Correct.   

Kennecke: So is it just different interpretations these other states have.

Kruger: Yes, that is entirely possible. 

“When there’s a resolution that would make this change now; because no one is disputing the treatment is needed. And no one is disputing how effective it is. So if you can fix it now, and other states have noticed the urgency and they’re fixing it now.  Waiting until 2021. It’s great if you’re in 2021, but we’re not,” Janklow said. 

Division of Insurance Deputy Director Kruger says the limits on the coverage plan for ABA therapy for autism are required because there is a limit on how much insurance benefits can increase. 

Ironically, Lindsey’s grandfather, the late South Dakota Governor Bill Janklow, issued a proclamation  back in 1999 calling for appropriate treatment for all children and adults with autism.

Copyright 2019 Nexstar Broadcasting, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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