How insurance could add $952 million for autism services in Ontario

In my previous article How to fix the Ontario Autism Program. Just look around, solutions are everywhere! I talked about the concept of mandating autism insurance to complement the Ontario Autism Program budget. Since then I wanted to know more about the number of Ontarians that have extended health insurance. Here’s what I have found.

As of 2018, the Canadian Life and Health Insurance Association (CLHIA) reports that there are 25 million Canadians with extended health care insurance, of which 9.8 million are from Ontario.

As of Q4 2018, Statistics Canada has Canada’s population at 37,242,571, with Ontario at 14,411,424.

The percentage of Canadians with extended health care is 67%, Ontario follows suit with 68%.

It is estimated that there are 40,000 kids and teens with Autism Spectrum Disorder in Ontario. If statistically this population falls in line with the 68% of Ontarians with extended health insurance, then 27,200 of these kids and teens would have this insurance.

So how much coverage could you get with extended health care for Autism related services? Well, that would depend on what the law says must be covered.

In the United States, 48 states and the District of Columbia have laws that require insurance coverage of autism services. Each state has a different law, but what you frequently see is coverage between $20,000 and $50,000 a year. Some states scale the amount based on age, while others mandate that the same amount is available no matter the age. The gold standard of Applied Behavioral Analysis (ABA) is almost always specifically in the law, while some states like California infer it through language like behavioral health treatment for pervasive developmental disorder or autism. Most states include Speech Language Therapy as well as Occupational Therapy. The increase in insurance costs was about 1%, however it was also noted that if the incidence of autism continues to increase and as more services are covered, the cost of insurance may increase 1 percent to 3 percent. More details can be viewed here: http://www.ncsl.org/research/health/autism-and-insurance-coverage-state-laws.aspx

So let’s take the mid-point of $35,000 per year for our example. The 27,200 kids and teens in Ontario with insurance would have as much as $952,000,000 available for autism services, or nearly 3 times the $320 million OAP budget. Collectively there could be $1.272 billion available for Ontario’s 40,000 kids and teens with Autism.

As a reminder, what I proposed in my previous article was a needs-based model that does not discriminate based on age or income. Those with insurance would have to use the insurance benefits first, and if additional services are needed, then the OAP would kick-in. Those without insurance would get needs-based services through the OAP. Keep in mind that lower-needs kids would typically not require autism interventions exceeding the $35,000 insurance amount, therefore they may never require government funded OAP services and supports.

Perhaps one day there will be a national strategy for autism where provinces and territories would be required by federal law to provide needs-based autism services. I’m not holding my breath for that day. Now is the time to make autism services available through insurance.