Updated December 20, 2018
One out of every 59 children has been diagnosed with autism or autism spectrum disorder (ASD), and its prevalence has been rising sharply over the past decade. Autism is four times more common in boys than girls.
There is no cure for autism, but early diagnosis and treatment can vastly improve the lives of those with autism. Children with autism need intensive therapy and special educational services. Adults with autism face an additional set of challenges. The law protects people with autism at all ages.
Autism is a neurodevelopmental disorder that is thought to be present from birth. It is characterized by impaired social development, poor communication skills, and repetitive or restrictive behaviors.
The autism spectrum includes autism, Asperger’s syndrome, and pervasive development disorder (PDD or PDD-NOS). People with autism can have high, normal or low intelligence. Both genetic and environmental factors contribute to the development of autism.
Most of the legislation to provide insurance coverage for the diagnosis, testing, and treatment of autism has been enacted in the last decade. Currently, 46 states and the District of Columbia require insurance coverage for services for autism spectrum disorders for children. In some states, mandatory coverage is limited to certain age groups, such as children up to age fifteen, while other states require insurance to cover services for young adults as well. Denial of coverage can be appealed in these states. Notably, Idaho, North Dakota, Tennessee, Washington, and West Virginia do not require insurance coverage for autism services for any age group.
If they have limited means, children and adults with autism qualify for Medicaid in some states. Some states make Medicaid services available through Home and Community Based Waivers or other Medicaid waivers.
The Individuals with Disabilities Education Act (IDEA), a law ensuring services to children with disabilities, does include autism in its list of disabilities that benefits from the protections of the IDEA law. However, just having autism is not enough to qualify for special education services or an IEP (see below). There must be evidence that your child’s autism or ASD negatively affects his or her educational performance.
IDEA provides that children with disabilities that affect their education are entitled to a free appropriate public education and an individualized education program (IEP) to help them meet individualized goals and get related services. A school district that is not able to offer the approproate services may pay to enroll a child with disabilities in a private school or school for children with disabilities that better meets the child’s needs. If your child's autism is having an impact on his or her education, ask your school district for an evaluation.
Historically some schools have used restraints and seclusion to limit the movement of children with challenging behaviors. About half of the states have laws that limit the use of restraints (limiting movement with straps or belts) and seclusion (locking in a room or enclosure). There is currently a federal bill called Keeping All Students Safe Act that's being considered in Congress; it would prohibit the use of seclusion and limit the use of restraints in all public schools and that would require that parents be informed when their children are restrained.
Children with autism that severely limits their functioning can qualify for Supplemental Security Income (SSI), if their household income is very low. After age 18, they may qualify for Social Security Disability Insurance or Disabled Adult Child benefits through Social Security. People with autism who need guardians to manage their financial and personal affairs can be assigned representative payees to receive their government benefits.
Parents and others can put money into an ABLE savings account for a child with autism without jeopardizing their eligibility for SSI or Medicaid. A supplemental needs trust or special needs trust can also hold assets to help pay for a disabled person’s care and expenses without disqualifying them from government benefits.
Some adults with severe autism are unable to work and receive cash benefits through SSDI and medical benefits through Medicare, or if they have very low household income, cash through SSI and medical benefits through Medicaid. Vocational and adult services programs are also available. Others can work regular jobs and support themselves. Those in the mainstream workplace can rely on the Americans with Disabilities Act (ADA) in order to receive accommodations that allow them to succeed at their jobs. Reasonable accommodations for autism might include time off work for medical appointments, scheduling changes, or changes to the job to limit contact with the public.
Each state has a protection and advocacy agency that addresses disability-related issues. Visit the National Disability Rights Network for a list of protection and advocacy agencies in your state.
