[Note: Shared for #AutisticHistory archive purposes. This is NOT An Autistic Ally.]
Oregon Sued Over Denying Autism Benefits to State Employees
April 30, 2014
Portland (April 30, 2014) — The state of Oregon has been sued over its blanket exclusion of insurance benefits for developmental disabilities in its state employees health plan by the parents of a six-year-old girl with autism who was denied coverage for applied behavior analysis (ABA). The complaint seeks certification as a class action on behalf of all Oregon state employees enrolled in the Oregon Public Employees Benefits Board (PEBB) health plan.
The plaintiffs are represented by attorneys Megan Glor and Ele Hamburger, a Seattle attorney who successfully litigated a similar class action brought against the Washington State Health Care Authority. The lawsuit charges that the PEBB developmental disability exclusion violates Oregon’s Unlawful Discrimination Against Persons with Disabilities Act, as well as the state and federal Mental Health Parity Acts.
“This case sends a message that all employers must cover essential health services for individuals with developmental disabilities, including children with autism,” said Glor. “Exclusions like the one in the PEBB plan are nothing more than rank discrimination.”
Paul Terdal, a volunteer autism advocate who helped lead passage of Oregon’s 2013 autism insurance reform law and worked with the plaintiffs, said the state was discriminating against its employees. “Not only does the State, as an employer, violate its own laws and public policy, it sets a bad example for other employers and insurers, and weakens the rule of law,” he said.
The suit marks the latest twist in the state’s efforts to implement autism insurance reform. The 2013 law was written to cover the state employee health plan, but the state then dropped PEBB after determining it was exempt as a self-funded plan regulated under federal law. Followup legislation this year to cover state employees died in committee last month.
The complaint, P.S. v PEBB, alleges that the state refused to cover P.S.’s ABA therapy solely because it was “related to autism” – even though Oregon’s Mental Health Parity law has required treatment of autism since 2005. Providence Health Plans, which administers the PEBB health plan, issued a denial letter stating that:
“Under Providence’s Plan, services ‘related to developmental disabilities, developmental delays or learning disabilities’ are specifically excluded from coverage. Because ABA services are related to Autism Spectrum Disorder, they are therefore not benefits covered by your plan.”
PEBB’s contract promises that it complies with Oregon’s Mental Health Parity law, which requires insurance plans to “provide coverage for expenses arising from treatment … mental or nervous conditions” – including autism “at the same level as, and subject to limitations no more restrictive than, those imposed on coverage or reimbursement of expenses arising from treatment for other medical conditions.”
P.S. charges that the PEBB developmental disability exclusion and exclusion of all ABA therapy as “experimental/investigational” breaches the PEBB contract, as modified by the state and federal Mental Health Parity Acts.
P.S. v. PEBB is the latest in a string of cases nationwide challenging exclusions and limitations on coverage of treatment for autism, including McHenry v PacificSource and A.F. v Providence in Oregon. It is the first case in Oregon, however, to involve a self-funded health benefit plan.
The Washington State caseresulted in a landmark decision that blanket exclusions of medically necessary mental health services, such as ABA for autism, violated Washington’s Mental Health Parity Act. The case eventually settled after the Washington State Health Care Authority removed its ABA therapy exclusion and provided a $3.5 million settlement fund for public employees who had paid out-of-pocket for medically necessary ABA therapy services.
The Oregon complaint was brought in state circuit court in Marion County.
The Autism Community Is Not The Autistic Community
Autistic people have fought the inclusion of ABA in therapy for us since before Autism Speaks, and other non-Autistic-led autism organizations, started lobbying legislation to get it covered by insurances and Medicaid.
ABA is a myth originally sold to parents that it would keep their Autistic child out of an institution. Today, parents are told that with early intervention therapy their child will either be less Autistic or no longer Autistic by elementary school, and can be mainstreamed in typical education classes. ABA is very expensive to pay out of pocket. Essentially, Autism Speaks has justified the big price tag up front will offset the overall burden on resources for an Autistic’s lifetime. The recommendation for this therapy is 40 hours a week for children and toddlers.
The original study that showed the success rate of ABA to be at 50% has never been replicated. In fact, the study of ABA by United States Department of Defense was denounced as a failure. Not just once, but multiple times. Simply stated: ABA doesn’t work. In study after repeated study: ABA (conversion therapy) doesn’t work.
What more recent studies do show: Autistics who experienced ABA therapy are at high risk to develop PTSD and other lifelong trauma-related conditions. Historically, the autism organizations promoting ABA as a cure or solution have silenced Autistic advocates’ opposition. ABA is also known as gay conversion therapy.
The ‘cure’ for Autistics not born yet is the prevention of birth.
The ‘cure’ is a choice to terminate a pregnancy based on ‘autism risk.’ The cure is abortion. This is the same ‘cure’ society has for Down Syndrome.
This is eugenics 2021. Instead of killing Autistics and disabled children in gas chambers or ‘mercy killings’ like in Aktion T4, it’ll happen at the doctor’s office, quietly, one Autistic baby at a time. Different approaches yes, but still eugenics and the extinction of an entire minority group of people.
Fact: You can’t cure Autistics from being Autistic.
Fact: You can’t recover an Autistic from being Autistic.
Fact: You can groom an Autistic to mask and hide their traits. Somewhat. … however, this comes at the expense of the Autistic child, promotes Autistic Burnout (this should not be confused with typical burnout, Autistic Burnout can kill Autistics), and places the Autistic child at high risk for PTSD and other lifelong trauma-related conditions.
[Note: Autism is NOT a disease, but a neurodevelopmental difference and disability.]
Fact: Vaccines Do Not Cause Autism.