By Rose Hoban
Melissa and Ralph Ripper consider themselves lucky. Even though they don’t make a lot of money – Melissa is a part-time preschool teacher and Ralph is a Raleigh firefighter – Melissa’s parents are able to help them out financially.
They’ve needed it. The Rippers’ older daughter, Abbey, 14, was born with autism and has some pretty profound disabilities as a result.
“Her sensory system is so unregulated, she’s either over- or under-stimulated,” Melissa said. “She likes to have the contact of hugging, which is one of her safe things, and the hugs are very intense. And instead of just releasing, she kind of shoves.
“We call it the hug-and-shove.”
Abbey goes to a special school for kids with autism that costs about $2,000 a month. And because she just transferred to that school, she currently has a one-on-one aide to help her with the transition. That costs an additional $2,000 each month. Melissa said that extra help should end soon.
But Melissa said Abbey would also benefit from some intensive therapy – in particular, applied behavioral analysis, a treatment in which a specially trained counselor works with an autistic child, repeating behaviors over and over until the child feels comfortable doing a task.
“It seemed to be a methodology that really helped her,” Melissa said.
And now the Rippers, and other families who have children with autism, will get the ABA paid for by their insurance, thanks to a bill that had final passage in the North Carolina General Assembly today and is on its way to the desk of Gov. Pat McCrory.
The bill has been seven years in the making, said Tracey Sheriff, head of the Autism Society of North Carolina.
“It’s been a long road,” he said.
Slowly building consensus
The bill, which requires insurance companies to pay for applied behavioral analysis and other intensive one-on-one therapies, was approved by both the North Carolina Senate and House of Representatives with overwhelming majorities.
So what took it so long?
For years, insurance companies resisted the bill, calling it a mandate and saying that implementing the measure would increase insurance premiums for others.
But evidence of what the bill did – or didn’t – do in other states indicated the costs were nominal: The cost increase in claims averages about 31 cents per insurance member, per month, or a total of about $3.70 per year to cover the intensive therapies.
And South Carolina and Virginia started covering autism therapies, along with dozens of other states around the country.
“The state was clearly in the minority,” said Rep. Chuck McGrady (R-Hendersonville), who ran the bill for years in the House. “People began to change their views.”
The bill evolved over several years, expanding from just covering the costs of ABA to also covering costs, less co-payments and deductibles, of more than two dozen evidence-based therapies, according to Sheriff.
The other big hurdle to the measure was overcoming objections to insurance mandates by many members of the General Assembly, in particular members of the Senate.
“The House passed it twice the last session and it never got out of committee in the Senate,” Sheriff said.
But over time, and with pressure from constituents, objections began to wane. The measure picked up support from former House Speaker Thom Tillis, who threw his weight behind the measure during his final term in the legislature.
“I also think the issue became more real for them,” McGrady said. “It was a grassroots effort, and we were able to paint a picture of why it was important.”
In 2014, the State Health Plan adopted the measure, leaving Blue Cross and Blue Shield of North Carolina as the only holdout.
Sheriff said the Autism Society and other advocates worked through the legislative interim to find consensus.
“We worked with all those groups and several other North Carolina-based advocates, providers and mental health professionals to come up with a bill that would be palatable to those concerned,” he said.
As it finally passed, the bill:
- provides up to $40,000 a year of coverage, indexed to inflation;
- only applies to beneficiaries covered by group plans held by businesses with more than 50 employees;
- covers children up to the age of 18; and
- goes into effect in July 2016.
Melissa Ripper said this has been a good legislative session for her family. Lawmakers also passed a bill earlier in the year allowing families like hers to put away up to $100,000 in a tax-deferred account to provide for Abbey.
“We know that she probably cannot live on her own,” Melissa said. “But in this new school, she’s learning how to do basic cooking skills and basic dressing and putting things on correctly with the label in the correct spot.”
She said the new measures are “huge.”
“I know my parents won’t be there forever, and I don’t expect them to do more than what they’ve already done,” Melissa said. “I know other families are out there who are not in such a lucky situation.”