State Regulated Plans
Benefits for applied behavior analysis treatment, speech therapy, physical therapy, and occupational therapy are limited to children through the age of 18 (some employers may choose to offer benefits beyond the age of 18, check with your employer). State Regulated plans cannot impose visit or annual dollar limits.
Self-funded (ERISA) Plans
Self-funded (ERISA) plans are not regulated by the State and are not required by law to provide the Autism benefit. It is best to contact your employer to inquire if they have adopted the Autism benefit. Each plan is determined by your employer and these plans can have age limits. If you find your employer has not adopted the benefit, contact AAoM and we can help you reach out to your employer and explain the benefits of adopting the Autism coverage.
Plans on the Marketplace
Plans on the marketplace cover the Autism benefit for children through the age of 18 and do not have limitations. Open enrollment to purchase a “Child-only” plan is typically November through December with an effective date of January 1. Several plan options are available with carriers throughout the State.
Effective April 1, 2013, Michigan began offering a Medicaid/MIChild benefit to provide treatment and supports for children with autism in our state. The Medicaid/MIChild benefit is available through your local Community Mental Health (CMH) agency. Individuals receiving the Medicaid/MIChild benefit may be eligible for ABA therapy, speech therapy, physical therapy, occupational therapy, respite, family training, and community living supports. The process to determine eligibility will include an intake process. If your child is deemed as possibly having an autism eligibility at intake, he or she will undergo a formal CMH eligibility diagnostic process. Depending on the outcome of that process, the amount and types of services the child will receive will be determined.
ABA therapy is now available for individuals under 21 who meet eligibility and medical necessity criteria.
Youth who have “aged out” of foster care can be covered under Medicaid until they reach age 26.
The Healthy Michigan Plan provides health care benefits to Michigan residents at a low cost so that more people can have health care coverage. Individuals are eligible for the Healthy Michigan Plan if they:
- Are age 19-64 years
- Have income at or below 133% of the federal poverty level* ($16,000 for a single person or $33,000 for a family of four)
- Do not qualify for or are not enrolled in Medicare
- Do not qualify for or are not enrolled in other Medicaid programs
- Are not pregnant at the time of application
- Are residents of the State of Michigan