Lawmakers Fight for Better Autism Care in Texas

In January, a significant bill will be reintroduced in the Texas legislature aimed at transforming the coverage of medical services and therapies for individuals with autism. This legislation seeks to address long-standing issues families face regarding access to necessary treatments, specifically Applied Behavior Analysis (ABA) therapy.

Experts in the field have highlighted the substantial challenges families encounter in securing both an ABA provider and insurance coverage. An expert from El Paso shared insights with KFOX14, emphasizing that the demand for ABA therapy continues to grow, particularly amid provider shortages. This situation has led to many families experiencing delays in obtaining evaluations and diagnoses for their children, which further complicates their access to essential services.

Currently, Texas law imposes a cap on the coverage of ABA therapy, limiting insurance providers to a maximum of $36,000 per year for therapy costs. Representative Phil Cortez, who represents District 117, which includes parts of San Antonio, is championing a new bill that could significantly alter this limitation. He stated, “House bill 4506 was about ensuring equity for individuals that have been diagnosed with autism. This bill would help to remove that cap and ensure that whatever healthcare is needed no matter the dollar cost that it would be covered.” This crucial change aims to provide families with the necessary support to address their children’s unique needs without the financial burden imposed by insurance limits.

Additionally, the proposed legislation would amend existing Texas law regarding autism therapy coverage. Currently, insurance is mandated to cover treatment only if a diagnosis occurs before the child’s 10th birthday. HB 4506 would change this requirement, allowing for a more inclusive approach to coverage. It also seeks to lessen the frequency of reevaluations, stipulating that those enrolled in ABA therapy would only need to be reassessed once every ten years. Cortez pointed out, “A family that has a son or daughter that was diagnosed with Autism, they have to be constantly reevaluated and rechecked to make sure they are still on the spectrum.” This change would ease some of the ongoing challenges families face in maintaining access to care.

Last year, Cortez successfully advanced the bill through the Texas House of Representatives, where it made progress to the state Senate. However, it did not reach Governor Greg Abbott’s desk. Cortez plans to reintroduce the bill this January, expressing confidence in its support from the El Paso delegation and advocating for its timely passage.

Cortez has encouraged parents and advocates to continue engaging with legislators to push for these necessary changes. Sharing personal stories and providing testimonies can have a profound impact on the legislative process, making a compelling case for reform that benefits families across the state.