State Insurance for Early Intervention Services
State legislation on the use of private insurance for Part C services
- Colorado
(PDF: 11kb) requires coverage of Part C services by public medical assistance and private health
insurance up to $6,067, including case management costs, per calendar or policy year. - Connecticut requires coverage of Part C services up to $6400 annually and exempt these costs from counting against any lifetime caps in a family's policy. This change was effective September 2009.
- Indiana also requires insurers to reimburse early intervention services if they are otherwise covered under a policy and exempts these payments from counting against any lifetime caps
- Virginia also requires coverage of Part C services up to $5,000 annually and exempt these costs from counting against any lifetime caps in a family's policy. The state also applies these provisions in a separate act to the insurance program for state employees.
- Massachusetts mandates that both indemnity and managed care plans cover early intervention.
- Provisions Respecting Domestic Companies (posted 5/11/11)
- Non-Profit Hospital Service Corporations (posted 5/11/11)
- Medical Service Corporations (posted 5/11/11)
- Health Maintenance Organizations (posted 5/11/11)
- New Hampshire requires coverage for Children's Early Intervention Therapy Services up to $3,200 per child per year not to exceed $9,600 by the child's third birthday.
- New Mexico requires coverage for children, from birth through three years of age, for or under the family, infant, toddler program administered by the department of health, provided eligibility criteria are met, for a maximum benefit $3,500 annually for medically necessary early intervention services. The services are provided as part of an individualized family service plan and delivered by certified and licensed personnel working in early intervention programs that are approved by the department of health. No payment shall be applied against any maximum lifetime or annual limits specified in the policy, health benefits plan or contract.
- New York
New York requires local early intervention program administrators to seek commercial insurance reimbursement for early intervention
services delivered to children whose commercial insurance policies are subject to New York State law. State law subrogates
municipalities to covered children's insurance policies for reimbursement of services delivered through the Early Intervention
Program, and provides the following protections for family insurance policies when used for early intervention services:
- Payment for early intervention services cannot be applied to the lifetime and annual monetary caps on the child/family's insurance policy.
- Parents cannot be asked to pay co-payments and deductibles (these costs are covered by the county and state).
- The visit limitations for covered services may apply to early intervention services; however, use of covered services cannot reduce the number of visits otherwise available under the plan (e.g., if the policy covers 10 visits of physical therapy, and the county is reimbursed for 10 visits of physical therapy used for the purposes of early intervention, the child/family will continue to have 10 visits available for health care purposes - such as services required after surgery or an accident).
- Rhode Island requires coverage of Part C services up to $5,000 annually per dependent child and exempts these costs from counting against any lifetime cap in a family's policy.
Health Insurance Legislation for Autism Spectrum Disorders (ASD)
Several states have enacted insurance legislation specific to autism spectrum disorders or have modified existing legislation to further define neurological disorders to include ASD for the purpose of covering needed services for eligible children. The following resources describe state health insurance legislation for ASD:
State Health Insurance for Autism Spectrum Disorders (ASD)
(February 2009) (PDF: 511kb) . Also available in
Excel format 
(XLS: 35kb) .
Information compiled by Anne Taylor Karasek formerly of NECTAC.
Easter Seals State Autism Profiles include: state insurance coverage for autism if available; the number of children with autism who have received the state’s special education services; Medicaid services specific for individuals with autism; educational programs provided to students with autism or training that focused on autism; special education criteria; other state-led resources; and, sponsors of autism legislation.
National Conference of State Legislatures (NCSL)
NCSL offers a searchable database that tracks autism legislation from the 2008 session to present. You may search legislation by state, topic, status, primary sponsor, bill number or keyword. In addition, the site summarizes current state insurance legislative approaches to meet the needs of children and adults with autism.