Northam signs law to remove age cap on autism coverage in Virginia

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RICHMOND, Va. (WWBT/Gray News) — UPDATE (May 28):

Jacob Korte, age 4, plays with his toys. A new Virginia law will help families whose children have autism. (Source: WWBT)

On Tuesday, May 28, Virginia Governor Ralph Northam officially signed into law a measure to expand insurance coverage for children with autism.

"After years of tireless effort from families and advocates, I was proud to sign legislation this morning to remove the age cap for autism insurance," Northam tweeted. "Now, all individuals with autism and their families will have access to the critical support they need."

Previously, Virginia law only mandated insurance coverage for autism diagnosis and services for children through age 10. The new law removes that age cap, providing coverage for medically necessary care for individuals with autism of all ages under state-regulated, large group plans starting in January 2020.

At the Autism Clinic at Virginia Tech, Dr. Angela Scarpa-Friedman leads research teams in studying autism.

"It's a neuro-developmental disorder, meaning that it starts early in development and is thought to have neuro-biological underpinnings," Friedman said.

Autism Spectrum Disorder is not easily defined. The disorder affects three primary areas of function.

"That includes social communication, and social interaction, and then also the presence of repetitive behaviors, preoccupations, and interests," she explained.

Many private insurance companies consider autism a condition that can't be remedied, so the insurance providers have been able to opt out of ongoing coverage of intensive therapy.

Leticia Fowler, a local mom, told us the applied behavior analysis therapy program her 10-year-old son undergoes is very expensive, and without insurance coverage, would be prohibitive.

Due to Virginia's age cap, they had to plan to end his treatment once he turned 11. Now, those plans won't have to happen.

"When they wake up at age 10, it doesn't mean that the autism went away," mother Molly Korte said. "It's always a part of them."

Dr. Scarpa-Friedman agrees: "Autism is a lifelong and chronic condition. As they change, the way that the symptoms present themselves also change."

The legislation is a light at the end of what has been a very long tunnel for those who have fought for this coverage and for tens of thousands of Virginia families and their children.

More than 3.5 million Americans live with an autism spectrum disorder.

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A major change is coming for children with autism growing up in Virginia.

On Tuesday, Gov. Ralph Northam will officially sign a bill into law that will help tens of thousands of families by expanding the insurance coverage children with autism receive.

That includes children like 4-year-old Jacob Korte. He happens to love lights, but to his parents, he is a light.

"We're very very proud of Jacob," said mother Molly Korte. "He is a good kid."

Jacob also has autism, which means he sees things differently and sometimes does things differently.

And he sometimes faces challenges others don't. One thing helping with those challenges is intensive therapy.

"They work on essential skills such as toilet training, interaction, how to have conversations with people, how to respond to his own name, these are things you just don't think about unless you have a child who is on the spectrum," said Korte.

The therapy is expensive. Many private insurance companies consider autism a condition that can't be remedied, so the insurance providers have been able to opt out of ongoing coverage of the therapy.

That makes the life-changing therapy largely unattainable for many Virginia families.

"We wouldn't be able to live in a house," said Korte. "On average, behavioral therapy is about $200 per hour. And most, I know for Jacob, he was recommended 20 hours a week."

For many families, that's been a reality - no coverage.

Lobbyists have fought for coverage for years, slowly raising the cap to 10 years old. That means kids 11 and older didn't necessarily get coverage for the same services that may have been covered the day before.

"When they wake up at age 10, it doesn't mean that the autism went away," said Korte. "It's always a part of them."

The Kortes are breathing a sigh of relief knowing Jacob is going to get the chance to get help at an affordable rate, long beyond his 10th birthday.

"It gives them a better chance to be a productive individual," said Korte, speaking to the benefit of the therapy.

"That's essentially what we want as parents for our kids," she said. "... The opportunity to be a productive individual and that's what this opportunity means for us."

The legislation is a light at the end of what has been a very long tunnel for those who have fought for this coverage. And for tens of thousands of Virginia families and their children.

The ceremonial bill signing will be at the Bell Tower on Tuesday.

The new law will provide coverage for medically necessary care for individuals with autism of all ages under state-regulated, large group plans starting in January 2020.

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